Provider Demographics
NPI:1003818287
Name:STEIN, JEFFREY J (ACNP)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:J
Last Name:STEIN
Suffix:
Gender:M
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:901 GAUSE BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2949
Mailing Address - Country:US
Mailing Address - Phone:985-867-8585
Mailing Address - Fax:985-867-3644
Practice Address - Street 1:1970 N HWY 190
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:985-867-8585
Practice Address - Fax:985-867-3644
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA082172363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1113174Medicaid
LA1113174Medicaid
P53008Medicare UPIN