Provider Demographics
NPI:1730662305
Name:SEMIEN, BRANDY LAURICE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:LAURICE
Last Name:SEMIEN
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 1:1747 IMPERIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5362
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1727 IMPERIAL BLVD BLDG 1B
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5392
Practice Address - Country:US
Practice Address - Phone:337-312-8617
Practice Address - Fax:337-721-2939
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP10115363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAF06182664OtherAANP CERTIFICATION NO.
LA2487931Medicaid