Provider Demographics
NPI:1285862649
Name:LANDRY, MICHELE LOUISE (ANP-BC)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LOUISE
Last Name:LANDRY
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6917
Mailing Address - Country:US
Mailing Address - Phone:337-470-2017
Mailing Address - Fax:337-981-9257
Practice Address - Street 1:4801 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6917
Practice Address - Country:US
Practice Address - Phone:337-470-2017
Practice Address - Fax:337-981-9257
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN100683-AP05798363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1816582Medicaid
5DM08Medicare PIN