Provider Demographics
NPI:1700821543
Name:DUHON, JAKE GARRETT (MED, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JAKE
Middle Name:GARRETT
Last Name:DUHON
Suffix:
Gender:M
Credentials:MED, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3341 KIRKPATRICK DR
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-3256
Mailing Address - Country:US
Mailing Address - Phone:337-616-9383
Mailing Address - Fax:337-824-4548
Practice Address - Street 1:2002 JOHNSON ST
Practice Address - Street 2:STE. 100
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-3646
Practice Address - Country:US
Practice Address - Phone:337-824-4547
Practice Address - Fax:337-824-4548
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAJ002182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer