Provider Demographics
NPI:1376546887
Name:DESHOTELS, JAMES M (APRN)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:M
Last Name:DESHOTELS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1575 CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-6153
Mailing Address - Country:US
Mailing Address - Phone:504-895-0853
Mailing Address - Fax:
Practice Address - Street 1:3900 S CARROLLTON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-4712
Practice Address - Country:US
Practice Address - Phone:504-482-0084
Practice Address - Fax:504-483-6016
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA142 8493Medicaid
LA142 8493Medicaid
LAP11294Medicare UPIN