Individual provider · NPI-1

Jacquelyn Dedral Nettles

Technician, Attendant Care Provider · Lafayette, LA

NPI number1427587609
StatusActive
Last updated in NPPESOct 17, 2023

Details

NPI
1427587609
Entity type
Individual (NPI-1)
Name
Jacquelyn Dedral Nettles
Sex
Female
Sole proprietor
No
Enumeration date
Jun 9, 2017
Certification date
Oct 17, 2023
Last updated
Oct 17, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
3747A0650X Technician, Attendant Care Provider––Yes

Practice location

315 S College Rd Ste 252
Lafayette, LA 70503-3212

Phone 337-269-1169 · Fax 337-235-1961

Mailing address

315 S College Rd Ste 252
Lafayette, LA 70503-3212

Phone 337-269-1169 · Fax 337-235-1961

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