Provider Demographics
NPI:1821590951
Name:MEAUX, TIFFANY LEBLANC (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LEBLANC
Last Name:MEAUX
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 N AVENUE L
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-3832
Mailing Address - Country:US
Mailing Address - Phone:337-788-3330
Mailing Address - Fax:337-788-3338
Practice Address - Street 1:1015 SAINT JOHN ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-6711
Practice Address - Country:US
Practice Address - Phone:337-269-5000
Practice Address - Fax:337-269-5001
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09840363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health