Provider Demographics
NPI:1790906493
Name:BABINEAUX, JEANNINE UTZMAN (FNP)
Entity Type:Individual
Prefix:
First Name:JEANNINE
Middle Name:UTZMAN
Last Name:BABINEAUX
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-4446
Mailing Address - Country:US
Mailing Address - Phone:337-474-8354
Mailing Address - Fax:
Practice Address - Street 1:2802 PINEVIEW ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70615-2063
Practice Address - Country:US
Practice Address - Phone:337-497-0233
Practice Address - Fax:337-439-5029
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN033154 A02178 PA363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1561126Medicaid