Provider Demographics
NPI:1780861468
Name:MANUEL, TERRELL S (DNP, FNP, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:TERRELL
Middle Name:S
Last Name:MANUEL
Suffix:
Gender:F
Credentials:DNP, FNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 82570
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70598-2570
Mailing Address - Country:US
Mailing Address - Phone:337-298-8293
Mailing Address - Fax:
Practice Address - Street 1:12038 GREENWELL SPRINGS PORT HUDSON ROAD
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791
Practice Address - Country:US
Practice Address - Phone:337-989-9932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO4812363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1810266Medicaid
LA3A540Medicare PIN