Provider Demographics
NPI:1588005128
Name:CHAMPAGNE, JOYCE PAULETTE (NP)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:PAULETTE
Last Name:CHAMPAGNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:PAULETTE
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:664 ROBERT BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-1648
Mailing Address - Country:US
Mailing Address - Phone:985-646-0360
Mailing Address - Fax:985-646-0362
Practice Address - Street 1:664 ROBERT BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-1648
Practice Address - Country:US
Practice Address - Phone:985-400-5988
Practice Address - Fax:985-867-3644
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07363363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2341537Medicaid
LA2341537Medicaid
LA295598YJQWMedicare PIN