=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841170321
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TESSI MARIE LEBLANC BORDELON FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2025
-----------------------------------------------------
Last Update Date | 09/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1211 COOLIDGE BLVD STE 303
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70503-2636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-232-6697
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 209 TRAIL POINTE DR
-----------------------------------------------------
City | SCOTT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70583-5435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-303-7721
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 242314
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------