Provider Demographics
NPI:1346883352
Name:DR TERRELL S MANUEL LLC
Entity Type:Organization
Organization Name:DR TERRELL S MANUEL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRELL
Authorized Official - Middle Name:S
Authorized Official - Last Name:MANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, DNP
Authorized Official - Phone:337-298-8293
Mailing Address - Street 1:PO BOX 82570
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70598-2570
Mailing Address - Country:US
Mailing Address - Phone:337-298-8293
Mailing Address - Fax:
Practice Address - Street 1:12038 GREENWELL SPRINGS/PORT HUDSON ROAD
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791
Practice Address - Country:US
Practice Address - Phone:337-298-8293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1810266Medicaid