Provider Demographics
NPI:1508347469
Name:BANDY, LAUREN DUPUIS (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:DUPUIS
Last Name:BANDY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:MARIE
Other - Last Name:DUPUIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1009 CHARITY ST
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-5302
Mailing Address - Country:US
Mailing Address - Phone:337-893-3443
Mailing Address - Fax:337-893-3439
Practice Address - Street 1:1009 CHARITY ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-5302
Practice Address - Country:US
Practice Address - Phone:337-893-3443
Practice Address - Fax:337-893-3439
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA309837363A00000X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2484613Medicaid