Provider Demographics
NPI:1780188144
Name:LAVERGNE, JENNY MEQUET (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:MEQUET
Last Name:LAVERGNE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:JENNY
Other - Middle Name:CECIL
Other - Last Name:MEQUET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1019 LEBLANC RD
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-7760
Mailing Address - Country:US
Mailing Address - Phone:337-322-3602
Mailing Address - Fax:
Practice Address - Street 1:1110 E SAINT PETER ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-3932
Practice Address - Country:US
Practice Address - Phone:337-364-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09726363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily