Provider Demographics
NPI:1124556428
Name:ARDOIN, ALICIA (NP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:ARDOIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10979 OAKDALE RD
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:LA
Mailing Address - Zip Code:71463-8019
Mailing Address - Country:US
Mailing Address - Phone:318-201-5119
Mailing Address - Fax:
Practice Address - Street 1:502 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:LA
Practice Address - Zip Code:71463-3043
Practice Address - Country:US
Practice Address - Phone:318-335-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09304363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily