Provider Demographics
NPI:1235487380
Name:DOUGLAS, LUCY (NP)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:DOUGLAS
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 1:1809 NORTHPOINTE LN
Mailing Address - Street 2:SUITE 203
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-3853
Mailing Address - Country:US
Mailing Address - Phone:318-255-3223
Mailing Address - Fax:318-255-3181
Practice Address - Street 1:1809 NORTHPOINTE LN
Practice Address - Street 2:SUITE 203
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-3853
Practice Address - Country:US
Practice Address - Phone:318-255-3223
Practice Address - Fax:318-255-3181
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06950364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA094105OtherRN
LAAP06950OtherNURSE PRACTITIONER