Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP05996 | LA |
NPI | 1003146101 |
---|---|
Provider Name | Mr. Jonathan A Seghorn |
First Address | New Iberia, LA 70560-5727 |
Second Address | New Iberia, LA 70560 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2010 |
Last Update Date | 24/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1813061 | (05) | LA |