Provider Demographics
NPI:1609850270
Name:LAKE ARTHUR HEALTH CLINIC LLC
Entity Type:Organization
Organization Name:LAKE ARTHUR HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MONLEZUN
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:337-774-0100
Mailing Address - Street 1:PO BOX 765
Mailing Address - Street 2:
Mailing Address - City:LAKE ARTHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70549-0765
Mailing Address - Country:US
Mailing Address - Phone:337-774-0100
Mailing Address - Fax:337-774-0111
Practice Address - Street 1:328 KELLOGG AVE
Practice Address - Street 2:
Practice Address - City:LAKE ARTHUR
Practice Address - State:LA
Practice Address - Zip Code:70549-4116
Practice Address - Country:US
Practice Address - Phone:337-774-0100
Practice Address - Fax:337-774-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO2500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1442488Medicaid
LA1442488Medicaid
LA5C863Medicare ID - Type UnspecifiedMEDICARE GROUP PART B NO.
LA1442488Medicaid