Jeremy Dedeaux, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP07961 Issued in LA

Practice address

2335 Church St
Suite E
Zachary, LA 70791-2700

Phone

(225) 654-3607

Fax

(225) 658-2262

NPI assigned

Jul 14, 2014

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• C & M Medical Services, Inc.

  • Emergency Medical Services (Emergency Medicine) Physician
  • Metairie, LA
  • NPI 1710903059
  Medicare reassignment NPD
• Convenient Care LLC

  • Urgent Care Clinic/Center
  • Baton Rouge, LA
  • NPI 1164422630
  Medicare reassignment NPD
• East Baton Rouge Emergency Physicians Group, LLC

  • Emergency Medicine Physician
  • Zachary, LA
  • NPI 1255894952
  Medicare reassignment NPD
• Convenient Care LLC

  • Urgent Care Clinic/Center
  • Hammond, LA
  • NPI 1225119225
  NPD
• Convenient Care LLC

  • Urgent Care Clinic/Center
  • Baton Rouge, LA
  • NPI 1972818250
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670284800000",
    "number": "1104233923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2335 MAIN STREET",
            "address_2": "SUITE E",
            "city": "ZACHARY",
            "state": "LA",
            "postal_code": "70791",
            "telephone_number": "225-654-3607",
            "fax_number": "225-658-2262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2335 CHURCH ST",
            "address_2": "SUITE E",
            "city": "ZACHARY",
            "state": "LA",
            "postal_code": "707912700",
            "telephone_number": "225-654-3607",
            "fax_number": "225-658-2262"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5439 Airline Hwy",
            "address_purpose": "LOCATION",
            "city": "Baton Rouge",
            "state": "LA",
            "postal_code": "708051712",
            "country_code": "US",
            "telephone_number": "225-358-4853",
            "fax_number": "225-358-2350",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEDEAUX",
        "first_name": "JEREMY",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-07-14",
        "last_updated": "2022-12-06",
        "certification_date": "2022-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "AP07961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2381547",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jdedeaux83538@direct.casso.us.com",
            "affiliation": "N",
            "endpointDescription": "FMOLHS-EPIC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "jdedeaux83538@direct.casso.us.com",
            "address_1": "5439 Airline Hwy",
            "city": "Baton Rouge",
            "state": "LA",
            "country_code": "US",
            "postal_code": "708051712",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0830.epihosted.com/FHIRPoxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FMOLHS FHIR URL",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "5439 Airline Hwy",
            "city": "Baton Rouge",
            "state": "LA",
            "country_code": "US",
            "postal_code": "708051712",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Meredith Darnell
• Gabrielle Darville
• Lynnette Faith David, ARNP-FNP
• Johnathan P Davis
• Sasha Tarshan Davis
• Christopher David Dedon, APRN
• Charlotte Rogers Delatorre, MS, CCC-SLP
• Delta Agencies, LLC
• Kimberly Sue Denham, MPT
• Mary K Deranger, PT

• Family Nurse Practitioner in Zachary, LA
• Providers in Zachary, LA by specialty
• Family Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.