Provider Demographics
NPI:1497372957
Name:ACADIANA PRACTITIONERS LLC
Entity Type:Organization
Organization Name:ACADIANA PRACTITIONERS LLC
Other - Org Name:ACADIANA PRACTITIONERS SUNSET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-942-5899
Mailing Address - Street 1:414 SAIZAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:PORT BARRE
Mailing Address - State:LA
Mailing Address - Zip Code:70577-5156
Mailing Address - Country:US
Mailing Address - Phone:337-447-4027
Mailing Address - Fax:337-585-2674
Practice Address - Street 1:166 OAK TREE PARK DR STE B
Practice Address - Street 2:
Practice Address - City:SUNSET
Practice Address - State:LA
Practice Address - Zip Code:70584-6135
Practice Address - Country:US
Practice Address - Phone:337-510-5010
Practice Address - Fax:337-585-2674
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACADIANA PRACTITIONERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-01
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty