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NPI Code Detail

MEDICARE: VALERIE PERRAULT JACKSON FNP

MEDICARE: VALERIE PERRAULT JACKSON FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WM0705XMedical-Surgical Registered NurseRN141287LA
2363LF0000XFamily Nurse PractitionerAP09737LA

General Provider Information

NPI Number : 1164925426
Entity Type Code : Individual
Provider Name (Legal Business Name) : VALERIE PERRAULT JACKSON FNP
Provider Business Mailing Address
First Line : 1003 EMANCIPATION BLVD
Second Line :
City : BROUSSARD
State : LA
Zip : 70518-7450
Country : US
Telephone Number : 225-718-5319
Fax Number :
Provider Business Practice Location Address
First Line : 1000 W PINHOOK RD STE 201
Second Line :
City : LAFAYETTE
State : LA
Zip : 70503-2464
Country : US
Telephone Number : 337-237-0650
Fax Number : 888-990-2781
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2018
Last Update Date : 06/13/2025

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Directions to “ VALERIE PERRAULT JACKSON FNP” Practice Location

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