Provider Demographics
NPI:1225414063
Name:WALTER, JACQUELINE BAUDIER (PNP-C)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:BAUDIER
Last Name:WALTER
Suffix:
Gender:F
Credentials:PNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-2631
Mailing Address - Country:US
Mailing Address - Phone:985-730-6670
Mailing Address - Fax:985-730-6671
Practice Address - Street 1:626 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-2631
Practice Address - Country:US
Practice Address - Phone:985-730-6670
Practice Address - Fax:985-730-6671
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08251363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics