Provider Demographics
NPI:1700821311
Name:MAY-LILLO, LEA ANN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LEA
Middle Name:ANN
Last Name:MAY-LILLO
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 1:809 HODGE WATSON RD
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:LA
Mailing Address - Zip Code:71225-7925
Mailing Address - Country:US
Mailing Address - Phone:318-614-2269
Mailing Address - Fax:
Practice Address - Street 1:484 COLLINS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:LA
Practice Address - Zip Code:71418-3388
Practice Address - Country:US
Practice Address - Phone:318-649-5300
Practice Address - Fax:318-649-0052
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO4969363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1582093Medicaid
LA4H962Medicare PIN
LA1582093Medicaid