Provider Demographics
NPI:1396583811
Name:REBEKAH YOUNG HOTARD PMHNP LLC
Entity type:Organization
Organization Name:REBEKAH YOUNG HOTARD PMHNP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:YOUNG
Authorized Official - Last Name:HOTARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-889-3682
Mailing Address - Street 1:4400 AMBASSADOR CAFFERY PKWY STE A
Mailing Address - Street 2:PMB 165
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6760
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:215 RUE FONTAINE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5742
Practice Address - Country:US
Practice Address - Phone:337-889-3682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1538924774OtherNPI 1