Provider Demographics
NPI:1053433102
Name:LAFEUILLADE, JODIE MARIE ROTH (RN, MSN, CPNP-AC)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:MARIE ROTH
Last Name:LAFEUILLADE
Suffix:
Gender:F
Credentials:RN, MSN, CPNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:901 W 38TH ST STE 410
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1162
Mailing Address - Country:US
Mailing Address - Phone:512-992-1378
Mailing Address - Fax:512-992-1379
Practice Address - Street 1:901 W 38TH ST STE 410
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1162
Practice Address - Country:US
Practice Address - Phone:512-992-1378
Practice Address - Fax:512-992-1379
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX740243363L00000X, 363LP0222X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care