Provider Demographics
NPI:1467793307
Name:MIDDLEBROOK-LOVETT, MANDY E (PA)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:E
Last Name:MIDDLEBROOK-LOVETT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:E
Other - Last Name:MIDDLEBROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2700 NAPOLEON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-6914
Mailing Address - Country:US
Mailing Address - Phone:504-899-5908
Mailing Address - Fax:504-899-5907
Practice Address - Street 1:2700 NAPOLEON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6914
Practice Address - Country:US
Practice Address - Phone:504-899-5908
Practice Address - Fax:504-899-5907
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPA00663363A00000X
LAPA.200599363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04174721Medicaid
LA2324632Medicaid
MS04174721Medicaid