Provider Demographics
NPI:1346827391
Name:NP MED OF ACADIANA LLC
Entity Type:Organization
Organization Name:NP MED OF ACADIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEIFFER
Authorized Official - Middle Name:BENGIE
Authorized Official - Last Name:WYBLE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, NP
Authorized Official - Phone:305-322-5100
Mailing Address - Street 1:207 SANDBAR LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7263
Mailing Address - Country:US
Mailing Address - Phone:305-832-2510
Mailing Address - Fax:
Practice Address - Street 1:4811 AMBASSADOR CAFFERY PKWY FL 4
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7265
Practice Address - Country:US
Practice Address - Phone:305-322-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty