MEDICARE: GABRIELLE ELYSE LAVERGNE

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
1	390200000X	Student in an Organized Health Care Education/Training Program		LA

General Provider Information

NPI Number	:	1194655696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLE ELYSE LAVERGNE

Provider Business Mailing Address
First Line	:	1602 W PINHOOK RD
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-3735
Country	:	US
Telephone Number	:	337-281-2722
Fax Number	:

Provider Business Practice Location Address
First Line	:	1602 W PINHOOK RD
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-3735
Country	:	US
Telephone Number	:	337-281-2722
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2026
Last Update Date	:	05/19/2026

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