Provider Demographics
NPI:1114994746
Name:CRENSHAW, LOUIS VICTOR II (NP C)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:VICTOR
Last Name:CRENSHAW
Suffix:II
Gender:M
Credentials:NP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12805 HIGHWAY 28 E
Mailing Address - Street 2:SUITE B
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-0734
Mailing Address - Country:US
Mailing Address - Phone:318-466-5151
Mailing Address - Fax:318-466-3535
Practice Address - Street 1:12805 HIGHWAY 28 E
Practice Address - Street 2:SUITE B
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-0734
Practice Address - Country:US
Practice Address - Phone:318-466-5151
Practice Address - Fax:318-466-3535
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN089438363L00000X
LAAP04196363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1151581Medicaid
LAP00014189OtherRAILROAD MEDICARE-PALMETT
P82965Medicare UPIN
LA4C622F735Medicare ID - Type Unspecified