Individual
JEREMY DEDEAUX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
2335 CHURCH ST, SUITE E, ZACHARY, LA 70791-2700
(225) 654-3607
(225) 658-2262
Mailing address
2335 MAIN STREET, SUITE E, ZACHARY, LA 70791
(225) 654-3607
(225) 658-2262
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP07961
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2381547
—
LA
Enumeration date
07/14/2014
Last updated
12/06/2022
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