Provider Demographics
NPI:1942235486
Name:HEBERT, MATTHEW J (C-FNP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:HEBERT
Suffix:
Gender:M
Credentials:C-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-5401
Mailing Address - Country:US
Mailing Address - Phone:985-872-2897
Mailing Address - Fax:985-872-4309
Practice Address - Street 1:569 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-5401
Practice Address - Country:US
Practice Address - Phone:985-872-2897
Practice Address - Fax:985-872-4309
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03370363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1552984Medicaid