Provider Demographics
NPI:1821095688
Name:LEGER, JASON CHARLES (NP)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:CHARLES
Last Name:LEGER
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 1:1233 WAYNE GILMORE CIR STE 450
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6405
Mailing Address - Country:US
Mailing Address - Phone:337-942-3006
Mailing Address - Fax:337-942-7744
Practice Address - Street 1:1233 WAYNE GILMORE CIR STE 450
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6405
Practice Address - Country:US
Practice Address - Phone:337-942-3006
Practice Address - Fax:337-942-7744
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03864363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1104051Medicaid
LA500021559OtherRR MEDICARE
LA500021559OtherRR MEDICARE
LAP40085Medicare UPIN