Individual
MRS. JACQUELINE TATE HENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
300 WEST ST. MARY BLVD, LAFAYETTE, LA 70506
(337) 233-1542
Mailing address
300 WEST ST. MARY BLVD, LAFAYETTE, LA 70506
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN105121-AP06557
LA
Other
Enumeration date
07/20/2011
Last updated
07/20/2011
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