Doctor Name: | JEREMY DEDEAUX |
NPI Number: | 1104233923 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | FNP-C |
License Number: | AP07961 |
Business Practice Address: | 2335 Church St Suite E Zachary, LA - 707912700 |
Business Phone Number: | 2256543607 |
Business Fax Number: | 2256582262 |
Mailing Address: | 2335 Main Street, Suite E ZACHARY |
State: | LA |
Postal Code: | 70791 |
Phone Number: | 2256543607 |
Fax Number: | 2256582262 |
NPI Enumeration Date: | 07/14/2014 |
NPI Last Update Date: | 12/18/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | AP07961 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |