Provider Demographics
NPI:1144633017
Name:GILBERT, JESSICA LOUISE (DO)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LOUISE
Last Name:GILBERT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MARK TWAIN DR
Mailing Address - Street 2:16
Mailing Address - City:RIVER RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70123-2484
Mailing Address - Country:US
Mailing Address - Phone:406-531-9592
Mailing Address - Fax:
Practice Address - Street 1:4228 HOUMA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-3004
Practice Address - Country:US
Practice Address - Phone:504-454-7878
Practice Address - Fax:504-883-3775
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA390200000X
LA304745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program