Provider Demographics
NPI:1346755154
Name:ACADIANA PRACTITIONERS LLC
Entity Type:Organization
Organization Name:ACADIANA PRACTITIONERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:337-447-4027
Mailing Address - Street 1:2124 HIGHWAY 742
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-0542
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:414 SAIZAN AVENUE
Practice Address - Street 2:
Practice Address - City:PORT BARRE
Practice Address - State:LA
Practice Address - Zip Code:70577
Practice Address - Country:US
Practice Address - Phone:337-447-4027
Practice Address - Fax:337-585-2674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
LA2203783812261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center