Basic Information
| Provider Information | |||||||||
| NPI: | 1144633017 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GILBERT | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | LOUISE | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 112 MARK TWAIN DR | ||||||||
| Address2: | 16 | ||||||||
| City: | RIVER RIDGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701232484 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4065319592 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4228 HOUMA BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700063004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044547878 | ||||||||
| FaxNumber: | 5048833775 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | LA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 304745 | LA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.