Provider Demographics
NPI:1255809166
Name:ACADIANA PRACTITIONERS LLC
Entity type:Organization
Organization Name:ACADIANA PRACTITIONERS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:337-447-4027
Mailing Address - Street 1:414 SAIZAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:PORT BARRE
Mailing Address - State:LA
Mailing Address - Zip Code:70577
Mailing Address - Country:US
Mailing Address - Phone:337-447-4027
Mailing Address - Fax:337-585-2674
Practice Address - Street 1:1119 PRUDHOMME CIR STE F
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6516
Practice Address - Country:US
Practice Address - Phone:337-942-5899
Practice Address - Fax:337-942-5978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty