Provider Demographics
NPI:1013407121
Name:LANDRY, EMILY RIVET (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:RIVET
Last Name:LANDRY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:MICHELLE
Other - Last Name:RIVET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1320 MARTIN LUTHER KING DR
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4886
Mailing Address - Country:US
Mailing Address - Phone:985-446-2021
Mailing Address - Fax:985-446-1546
Practice Address - Street 1:1320 MARTIN LUTHER KING DR
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4886
Practice Address - Country:US
Practice Address - Phone:985-446-2021
Practice Address - Fax:985-446-1546
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09801363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily