Provider Demographics
NPI:1538596739
Name:BREAUX, REBECCA M (NP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:BREAUX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:1115 WEBER ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70538-4124
Mailing Address - Country:US
Mailing Address - Phone:337-828-2550
Mailing Address - Fax:337-355-2333
Practice Address - Street 1:1709 RIDGEFIELD RD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4333
Practice Address - Country:US
Practice Address - Phone:985-446-7341
Practice Address - Fax:985-446-3773
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2019-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAAP07485363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2349546Medicaid
LA2349546Medicaid