MEDICARE: JILL P DEBOUCHEL 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
1	363LF0000X	Family Nurse Practitioner	AP06639	LA
2	207K00000X	Allergy & Immunology Physician	AP06639	LA
3	207Y00000X	Otolaryngology Physician	AP06639	LA

General Provider Information

NPI Number	:	1750651618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL P DEBOUCHEL FNP

Provider Business Mailing Address
First Line	:	1151 BARATARIA BLVD STE 3100
Second Line	:
City	:	MARRERO
State	:	LA
Zip	:	70072-3083
Country	:	US
Telephone Number	:	504-934-8462
Fax Number	:	504-371-3811

Provider Business Practice Location Address
First Line	:	2611 JACKSON BLVD
Second Line	:
City	:	CHALMETTE
State	:	LA
Zip	:	70043-2959
Country	:	US
Telephone Number	:	504-934-8461
Fax Number	:	504-371-3811

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

Provider Enumeration Date	:	01/10/2012
Last Update Date	:	03/05/2026

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