Provider Demographics
NPI:1619437522
Name:LUKE LEONARDS APRN
Entity Type:Organization
Organization Name:LUKE LEONARDS APRN
Other - Org Name:LUKE LEONARDS APRN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:LEONARDS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-C
Authorized Official - Phone:337-250-0972
Mailing Address - Street 1:124 KELLOGG AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6280
Mailing Address - Country:US
Mailing Address - Phone:337-250-0972
Mailing Address - Fax:
Practice Address - Street 1:2520 N UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507-5306
Practice Address - Country:US
Practice Address - Phone:337-806-8934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2486110Medicaid