Provider Demographics
NPI:1013573583
Name:LANDRY, TOMMIE JR (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MR
First Name:TOMMIE
Middle Name:
Last Name:LANDRY
Suffix:JR
Gender:M
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 W 134TH PL
Mailing Address - Street 2:
Mailing Address - City:CUT OFF
Mailing Address - State:LA
Mailing Address - Zip Code:70345-4128
Mailing Address - Country:US
Mailing Address - Phone:985-632-6233
Mailing Address - Fax:985-632-7526
Practice Address - Street 1:144 W 134TH PL
Practice Address - Street 2:
Practice Address - City:CUT OFF
Practice Address - State:LA
Practice Address - Zip Code:70345-4128
Practice Address - Country:US
Practice Address - Phone:985-632-6233
Practice Address - Fax:985-632-7526
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-10
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA203777363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2500724Medicaid