Provider Demographics
NPI:1275583288
Name:MECHE, JO ANN STANLEY (NP)
Entity Type:Individual
Prefix:MRS
First Name:JO ANN
Middle Name:STANLEY
Last Name:MECHE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 W HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-4441
Mailing Address - Country:US
Mailing Address - Phone:318-281-4450
Mailing Address - Fax:318-281-4464
Practice Address - Street 1:355 W HICKORY AVE
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-4441
Practice Address - Country:US
Practice Address - Phone:318-281-4450
Practice Address - Fax:318-281-4464
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04115363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1147061Medicaid
LAP79640Medicare UPIN
LA4C577Medicare PIN