Organization · NPI-2
Acadiana Practitioners LLC
Clinic/Center, Rural Health · Opelousas, LA
NPI number1255809166
StatusActive
Last updated in NPPESMar 2, 2020
Details
- NPI
- 1255809166
- Entity type
- Organization (NPI-2)
- Legal business name
- Acadiana Practitioners LLC
- Organization subpart
- No
- Enumeration date
- Nov 8, 2018
- Certification date
- Mar 2, 2020
- Last updated
- Mar 2, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QR1300X | Clinic/Center, Rural Health | – | – | Yes |
| 261Q00000X | Clinic/Center | – | – | |
| 363LF0000X | Nurse Practitioner, Family | – | – |
Other names
- Acadiana Practitioners Opelousas (Doing Business As)
Practice location
1119 Prudhomme Cir Ste FOpelousas, LA 70570-6516
Phone 337-942-5899 · Fax 337-942-5978
Mailing address
414 Saizan AvenuePort Barre, LA 70577
Phone 337-447-4027 · Fax 337-585-2674
Authorized official
Dustin Joseph Miller
President
3374474027
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