Provider Demographics
NPI:1164275624
Name:LANDRY, DELICIA JOVAN (FNP-C)
Entity Type:Individual
Prefix:
First Name:DELICIA
Middle Name:JOVAN
Last Name:LANDRY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4404 ROSELAND DR
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEN
Mailing Address - State:LA
Mailing Address - Zip Code:70767-4327
Mailing Address - Country:US
Mailing Address - Phone:225-776-7862
Mailing Address - Fax:
Practice Address - Street 1:4404 ROSELAND DR
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767-4327
Practice Address - Country:US
Practice Address - Phone:225-776-7862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA234910363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily