Provider Demographics
NPI:1972126001
Name:ANYAMA, AUGUSTA CHIKA
Entity Type:Individual
Prefix:MS
First Name:AUGUSTA
Middle Name:CHIKA
Last Name:ANYAMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 DULLES DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-2716
Mailing Address - Country:US
Mailing Address - Phone:337-223-9487
Mailing Address - Fax:888-511-5650
Practice Address - Street 1:1921 DULLES DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-2716
Practice Address - Country:US
Practice Address - Phone:337-223-9487
Practice Address - Fax:888-511-5650
Is Sole Proprietor?:No
Enumeration Date:2020-05-23
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA215584363LP0808X
TX145787363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2543512Medicaid