Provider Demographics
NPI:1174750301
Name:FOURNET, BYRON KEITH JR (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:BYRON
Middle Name:KEITH
Last Name:FOURNET
Suffix:JR
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:LA
Mailing Address - Zip Code:70558
Mailing Address - Country:US
Mailing Address - Phone:337-456-6523
Mailing Address - Fax:337-456-6521
Practice Address - Street 1:4811 AMBASSADOR CAFFERY PARKWAY
Practice Address - Street 2:SUITE 401A
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508
Practice Address - Country:US
Practice Address - Phone:337-456-6523
Practice Address - Fax:337-456-6521
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05857363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1801089Medicaid
LA3B1976833Medicare PIN