Individual
MR. MARK DECLOUET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
315 AUDUBON BLVD, LAFAYETTE, LA 70503-2610
(337) 522-7573
(337) 210-3058
Mailing address
PO BOX 53709, LAFAYETTE, LA 70505-3709
(877) 294-7247
(337) 210-3058
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP08202
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2386158
—
LA
Enumeration date
08/31/2011
Last updated
12/29/2020
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