1750767927 NPI number — MRS. MINDY GAUBERT HYMEL PA-C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750767927 NPI number — MRS. MINDY GAUBERT HYMEL PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HYMEL
Provider First Name:
MINDY
Provider Middle Name:
GAUBERT
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GAUBERT
Provider Other First Name:
MINDY
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750767927
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
122 REFUGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LULING
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70070-3239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-201-1254
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1057 PAUL MAILLARD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LULING
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70070-4349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-785-6242
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA.200878 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: PA00558 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2402463 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09051054 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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