Provider Demographics
NPI:1093033417
Name:LANDRY, AMY LEBLANC (NP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LEBLANC
Last Name:LANDRY
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5000 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:BLDG # 1
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6984
Mailing Address - Country:US
Mailing Address - Phone:337-261-0928
Mailing Address - Fax:337-233-7773
Practice Address - Street 1:5000 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:BLDG #1
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6984
Practice Address - Country:US
Practice Address - Phone:337-261-0928
Practice Address - Fax:337-233-7773
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAAP06089363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2104438Medicaid
LA3B893Medicare PIN