Provider Demographics
NPI:1114377124
Name:COURVILLE, JEREMY BRANDON (FNP-C)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:BRANDON
Last Name:COURVILLE
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1786 BEAUREGARD RD
Mailing Address - Street 2:
Mailing Address - City:SIMMESPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71369-2336
Mailing Address - Country:US
Mailing Address - Phone:318-240-3199
Mailing Address - Fax:
Practice Address - Street 1:6450 LA HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:BATCHELOR
Practice Address - State:LA
Practice Address - Zip Code:70715-3212
Practice Address - Country:US
Practice Address - Phone:225-492-3775
Practice Address - Fax:225-492-3782
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08838363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily