Provider Demographics
NPI:1790679579
Name:CLINTON FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:CLINTON FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JARREAU
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:225-522-3410
Mailing Address - Street 1:10793 PLANK ROAD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70722
Mailing Address - Country:US
Mailing Address - Phone:225-522-3410
Mailing Address - Fax:
Practice Address - Street 1:10793 PLANK ROAD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:LA
Practice Address - Zip Code:70722
Practice Address - Country:US
Practice Address - Phone:225-522-3410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty