Provider Demographics
NPI:1417349457
Name:JANA GAUTREAUX LLC
Entity Type:Organization
Organization Name:JANA GAUTREAUX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUTREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:225-333-9559
Mailing Address - Street 1:101 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70538-5430
Mailing Address - Country:US
Mailing Address - Phone:225-333-9559
Mailing Address - Fax:
Practice Address - Street 1:814 MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:LA
Practice Address - Zip Code:70538-5441
Practice Address - Country:US
Practice Address - Phone:043-020-3845
Practice Address - Fax:985-231-0213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-27
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 363LP0808X
LA06792363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2194569Medicaid