Provider Demographics
NPI:1356862858
Name:BAGWELL, LANDRY CHARMAYNE (NP)
Entity Type:Individual
Prefix:
First Name:LANDRY
Middle Name:CHARMAYNE
Last Name:BAGWELL
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 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:318-966-8850
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:1100 N 18TH ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5780
Practice Address - Country:US
Practice Address - Phone:318-966-8850
Practice Address - Fax:318-966-8851
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09320363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care