Provider Demographics
NPI:1871030064
Name:TRAHAN, LEAH MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:TRAHAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:TRAHAN
Other - Last Name:SIMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:900 E SAINT MARY BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2378
Mailing Address - Country:US
Mailing Address - Phone:337-504-3640
Mailing Address - Fax:337-504-3640
Practice Address - Street 1:900 E SAINT MARY BLVD STE 104
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2378
Practice Address - Country:US
Practice Address - Phone:337-504-3640
Practice Address - Fax:337-504-3640
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09211363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2438808Medicaid
LA2438808Medicaid