Provider Demographics
NPI:1447618038
Name:LANDRY, AMBER ELAINE
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:ELAINE
Last Name:LANDRY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:AMBER
Other - Middle Name:ELAINE
Other - Last Name:LANDRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN,FNP-C
Mailing Address - Street 1:20050 CRESTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5207
Mailing Address - Country:US
Mailing Address - Phone:225-907-4742
Mailing Address - Fax:
Practice Address - Street 1:54033 HIGHWAY 1062
Practice Address - Street 2:SUITE B
Practice Address - City:LORANGER
Practice Address - State:LA
Practice Address - Zip Code:70446
Practice Address - Country:US
Practice Address - Phone:985-606-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08547363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily