Provider Demographics
NPI:1336199280
Name:LEBLANC, ALLISON ENGLE (PA)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:ENGLE
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16220 AIRLINE HWY
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-4248
Mailing Address - Country:US
Mailing Address - Phone:225-744-1111
Mailing Address - Fax:
Practice Address - Street 1:16220 AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-4248
Practice Address - Country:US
Practice Address - Phone:225-744-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA200065363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1806170Medicaid
MS05226311Medicaid
LAQ66988Medicare UPIN
LA1806170Medicaid