Provider Demographics
NPI:1437109535
Name:MERRYVILLE FAMILY CLINIC, LLC
Entity Type:Organization
Organization Name:MERRYVILLE FAMILY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:AUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:337-825-8600
Mailing Address - Street 1:915 N BRYAN ST
Mailing Address - Street 2:
Mailing Address - City:MERRYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70653-3302
Mailing Address - Country:US
Mailing Address - Phone:337-825-8600
Mailing Address - Fax:337-825-8666
Practice Address - Street 1:915 N BRYAN ST
Practice Address - Street 2:
Practice Address - City:MERRYVILLE
Practice Address - State:LA
Practice Address - Zip Code:70653-3302
Practice Address - Country:US
Practice Address - Phone:337-825-8600
Practice Address - Fax:337-825-8666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN 032217APO4266363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1446025Medicaid
LA5CT07Medicare ID - Type UnspecifiedCLINIC