Basic Information
| Provider Information | |||||||||
| NPI: | 1285243642 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARMOUCHE | ||||||||
| FirstName: | JIMANESHA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1040 BRIDGETOWNE LN | ||||||||
| Address2: | |||||||||
| City: | BREAUX BRIDGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705178124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372585027 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1211 COOLIDGE BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705032638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372898400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2020 | ||||||||
| LastUpdateDate: | 07/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 214903 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.