# JOHNATHAN LARROQUETTE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679310072
- **Authorized official:** JOHNATHAN THERON LARROQUETTE PMHNP (CERTIFIED NURSE PRACTITIONER)
- **Authorized official phone:** (985) 247-1394

## Contact information

- **Practice address:** 1214 COOLIDGE BLVD, LAFAYETTE, LA 70503-2621
- **Practice address phone:** (337) 289-7991
- **Mailing address:** PO BOX 51906, LAFAYETTE, LA 70505-1906

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 07/11/2024
- **Last updated:** 10/09/2024