Mark Declouet, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP08202 Issued in LA

Practice address

315 Audubon Blvd
Lafayette, LA 70503-2610

Phone

(337) 522-7573

Fax

(337) 210-3058

NPI assigned

Aug 31, 2011

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1314748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609200000000",
    "number": "1386925683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 53709",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705053709",
            "telephone_number": "877-294-7247",
            "fax_number": "337-210-3058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 AUDUBON BLVD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705032610",
            "telephone_number": "337-522-7573",
            "fax_number": "337-210-3058"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5448 Provine Pl Ste A",
            "address_purpose": "LOCATION",
            "city": "Alexandria",
            "state": "LA",
            "postal_code": "713033983",
            "country_code": "US",
            "telephone_number": "318-545-2451",
            "fax_number": "866-990-8296",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "217 Brevard Ct Ste C",
            "address_purpose": "LOCATION",
            "city": "Alexandria",
            "state": "LA",
            "postal_code": "713033997",
            "country_code": "US",
            "telephone_number": "318-545-2451",
            "fax_number": "866-990-8296",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "44 Versailles Blvd",
            "address_purpose": "LOCATION",
            "city": "Alexandria",
            "state": "LA",
            "postal_code": "713033960",
            "country_code": "US",
            "telephone_number": "318-445-5111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DECLOUET",
        "first_name": "MARK",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-08-31",
        "last_updated": "2020-12-29",
        "certification_date": "2020-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "LA",
            "license": "AP08202",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2386158",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jonathan Deck, DO
• Declouet Mental Health Solutions, LLC
• Declouet Psychiatric Services, LLC
• Monique Bianca Declouet-Dixon, FNP
• Alyssa Declouet, PMHNP
• Matthew Alexander Declouet, PMHNP
• Paige Declouet, PMHNP
• Edolia Declouette, MBA
• Danielle Decou, D.D.S.
• Jon S Decuir Jr., MD

• Psychiatric/Mental Health Nurse Practitioner in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.