Provider Demographics
NPI:1073639308
Name:LAGRANGE, CYNTHIA KAY (CRNP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:KAY
Last Name:LAGRANGE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:KAY
Other - Last Name:KEMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:6809 W CALCASIEU DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-0452
Mailing Address - Country:US
Mailing Address - Phone:804-513-0336
Mailing Address - Fax:337-475-4713
Practice Address - Street 1:6809 W CALCASIEU DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-0452
Practice Address - Country:US
Practice Address - Phone:804-513-0336
Practice Address - Fax:337-475-4713
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166794363LN0005X
LAAP08054363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care