Provider Demographics
NPI:1265790380
Name:LEWIS, CELESTE MARIE (APRN/APMHNP)
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:MARIE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:APRN/APMHNP
Other - Prefix:
Other - First Name:CELESTE
Other - Middle Name:LEWIS
Other - Last Name:GREENBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 HOLIDAY BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5088
Mailing Address - Country:US
Mailing Address - Phone:985-624-2942
Mailing Address - Fax:985-231-1373
Practice Address - Street 1:201 HOLIDAY BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5088
Practice Address - Country:US
Practice Address - Phone:985-624-2942
Practice Address - Fax:985-231-1373
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06714363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2197291Medicaid