Basic Information
| Provider Information | |||||||||
| NPI: | 1225414063 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALTER | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | BAUDIER | ||||||||
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| Credential: | PNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 626 SUPERIOR AVE | ||||||||
| Address2: | |||||||||
| City: | BOGALUSA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704272631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9857306670 | ||||||||
| FaxNumber: | 9857306671 | ||||||||
| Practice Location | |||||||||
| Address1: | 626 SUPERIOR AVE | ||||||||
| Address2: | |||||||||
| City: | BOGALUSA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704272631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9857306670 | ||||||||
| FaxNumber: | 9857306671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2015 | ||||||||
| LastUpdateDate: | 08/04/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | AP08251 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.