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General NPI Number Information
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NPI Number | 1649098724
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Entity Type | Individual
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Provider Name | JILLIAN RAE HENRY WHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/28/2024
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 2309 E MAIN ST STE C
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City | NEW IBERIA
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State | LA
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Zip | 70560-4046
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Country | US
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Telephone | 337-256-8779
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Fax |
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Provider Business Mailing Address
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Address Line | 2309 E MAIN ST STE C
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City | NEW IBERIA
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State | LA
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Zip | 70560-4046
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 241502
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License Number State | LA
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