Provider Demographics
NPI:1891962437
Name:TRAHAN, JUDY BROUSSARD (NP)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:BROUSSARD
Last Name:TRAHAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:ANN
Other - Last Name:BROUSSARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:257-655-7272
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:4212 W CONGRESS ST
Practice Address - Street 2:SUITE 3600
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6765
Practice Address - Country:US
Practice Address - Phone:337-988-2004
Practice Address - Fax:337-981-5012
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN088774 APO5432363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3A6711255Medicare PIN