Provider Demographics
NPI:1083134670
Name:HEBERT, LEAH MICHELLE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:MICHELLE
Last Name:HEBERT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:LEAH
Other - Middle Name:MICHELLE
Other - Last Name:LOWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:200 CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3870
Mailing Address - Country:US
Mailing Address - Phone:800-896-9698
Mailing Address - Fax:
Practice Address - Street 1:4200 NELSON RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4118
Practice Address - Country:US
Practice Address - Phone:337-474-6370
Practice Address - Fax:337-475-4143
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09402363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily