Provider Demographics
NPI:1982836656
Name:MIGUES, STACIE B (FNP-C)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:B
Last Name:MIGUES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1097 NORTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70538-3407
Mailing Address - Country:US
Mailing Address - Phone:337-923-7045
Mailing Address - Fax:337-923-4007
Practice Address - Street 1:100 LIVE OAK ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:LA
Practice Address - Zip Code:70514-0000
Practice Address - Country:US
Practice Address - Phone:337-923-7045
Practice Address - Fax:337-923-4007
Is Sole Proprietor?:No
Enumeration Date:2009-08-14
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN097848-AP05867363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1810291Medicaid