Provider Demographics
NPI:1639502552
Name:TRAHAN, LEAH FONTENOT (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:FONTENOT
Last Name:TRAHAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4630 AMBASSADOR CAFFERY PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6949
Mailing Address - Country:US
Mailing Address - Phone:337-521-9455
Mailing Address - Fax:337-521-9456
Practice Address - Street 1:4630 AMBASSADOR CAFFERY PKWY STE 104
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6949
Practice Address - Country:US
Practice Address - Phone:337-521-9455
Practice Address - Fax:337-521-9456
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07446363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily