MEDICARE: JERICA LAFAYETTE

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	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1477231900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERICA LAFAYETTE

Provider Business Mailing Address
First Line	:	9442 COUNTRY LAKE DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70817-7027
Country	:	US
Telephone Number	:	225-223-8053
Fax Number	:

Provider Business Practice Location Address
First Line	:	149 CORA DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70815-4202
Country	:	US
Telephone Number	:	225-223-8053
Fax Number	:

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

Provider Enumeration Date	:	07/05/2023
Last Update Date	:	07/05/2023

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Directions to “ JERICA LAFAYETTE ” Practice Location

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