Provider Demographics
NPI:1790537579
Name:SERENITY PSYCHIATRIC CARE LLC
Entity Type:Organization
Organization Name:SERENITY PSYCHIATRIC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER / PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:ISABELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUBOIS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:337-523-6482
Mailing Address - Street 1:10904 HARGROVE RD
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-6328
Mailing Address - Country:US
Mailing Address - Phone:337-523-6482
Mailing Address - Fax:
Practice Address - Street 1:5520 JOHNSTON ST STE K
Practice Address - Street 2:PMB 1205
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503
Practice Address - Country:US
Practice Address - Phone:337-523-6482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA234219OtherAPRN-CNP PROFESSIONAL LICENSE