Provider Demographics
NPI:1942931076
Name:LANCON, JAMIE (APRN, CNM)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:LANCON
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 THRUSH LOOP
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6218
Mailing Address - Country:US
Mailing Address - Phone:337-258-2245
Mailing Address - Fax:
Practice Address - Street 1:803 S MORGAN AVE
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-4921
Practice Address - Country:US
Practice Address - Phone:337-453-4346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA219429367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife