Provider Demographics
NPI:1104290881
Name:ST. ROMAIN, JAMIE BAYHAM (FNP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:BAYHAM
Last Name:ST. ROMAIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-4608
Mailing Address - Country:US
Mailing Address - Phone:337-457-3135
Mailing Address - Fax:
Practice Address - Street 1:102 S 2ND ST
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-4608
Practice Address - Country:US
Practice Address - Phone:337-457-3135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-18
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08292363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2410393Medicaid
LA478123YPRKOtherMEDICARE PTAN-GROUP