Provider Demographics
NPI:1467283184
Name:NP MOM LLC
Entity type:Organization
Organization Name:NP MOM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:DUCHARME
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:337-210-5827
Mailing Address - Street 1:1921 KALISTE SALOOM RD STE 117
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6183
Mailing Address - Country:US
Mailing Address - Phone:337-210-5827
Mailing Address - Fax:844-482-4077
Practice Address - Street 1:1921 KALISTE SALOOM RD STE 117
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6183
Practice Address - Country:US
Practice Address - Phone:337-210-5827
Practice Address - Fax:844-482-4077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty