Basic Information
| Provider Information | |||||||||
| NPI: | 1811352180 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CURTIS | ||||||||
| FirstName: | JOHILE | ||||||||
| MiddleName: | EVERETTE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4176 | ||||||||
| Address2: | |||||||||
| City: | HOUMA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703614176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858765864 | ||||||||
| FaxNumber: | 9858760317 | ||||||||
| Practice Location | |||||||||
| Address1: | 6550 MAIN ST | ||||||||
| Address2: | SUITE 1000 | ||||||||
| City: | ZACHARY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707914092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2256541559 | ||||||||
| FaxNumber: | 2256546212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2015 | ||||||||
| LastUpdateDate: | 05/04/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 124710 | LA | N | Nursing Service Providers | Registered Nurse | 363L00000X | AP08609 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 2415310 | 05 | LA | MEDICAID |