Provider Demographics
NPI:1790079465
Name:DYER, MICHELLE TRAHAN (APRN, APMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:TRAHAN
Last Name:DYER
Suffix:
Gender:F
Credentials:APRN, APMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 BAYOU PINES EAST DR STE C
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7596
Mailing Address - Country:US
Mailing Address - Phone:337-602-1462
Mailing Address - Fax:337-478-9828
Practice Address - Street 1:748 BAYOU PINES EAST DR STE C
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7596
Practice Address - Country:US
Practice Address - Phone:337-602-1462
Practice Address - Fax:337-602-1464
Is Sole Proprietor?:No
Enumeration Date:2011-05-30
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06442363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health