Provider Demographics
NPI:1790403988
Name:O'CONNOR, JOEL (NP)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 DOUBLE J RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-6353
Mailing Address - Country:US
Mailing Address - Phone:985-634-4060
Mailing Address - Fax:985-256-5687
Practice Address - Street 1:4430 HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3310
Practice Address - Country:US
Practice Address - Phone:985-634-4060
Practice Address - Fax:985-256-5687
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA226664363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health