Provider Demographics
NPI:1477268423
Name:ROME, LINDA BAIRD (NBC-HWC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:BAIRD
Last Name:ROME
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 W CLEMENT ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-4225
Mailing Address - Country:US
Mailing Address - Phone:337-298-1680
Mailing Address - Fax:
Practice Address - Street 1:126 W CLEMENT ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-4225
Practice Address - Country:US
Practice Address - Phone:337-298-1680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA123Medicaid