Provider Demographics
NPI:1003057076
Name:GAUTREAUX, JEANNE NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:NICOLE
Last Name:GAUTREAUX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3822 MONTE VISTA DR
Mailing Address - Street 2:
Mailing Address - City:ADDIS
Mailing Address - State:LA
Mailing Address - Zip Code:70710-3004
Mailing Address - Country:US
Mailing Address - Phone:225-235-9308
Mailing Address - Fax:
Practice Address - Street 1:6550 MAIN ST
Practice Address - Street 2:SUITE 2000
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-4092
Practice Address - Country:US
Practice Address - Phone:225-235-9308
Practice Address - Fax:225-658-1304
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-20
Last Update Date:2020-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.204395207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1974722Medicaid