Provider Demographics
NPI:1700172988
Name:LEJEUNE, STACY (APRN-FNP)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:
Last Name:LEJEUNE
Suffix:
Gender:F
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:LEJEUNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN-FNP
Mailing Address - Street 1:46 LOUIS PRIMA DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5903
Mailing Address - Country:US
Mailing Address - Phone:985-892-7070
Mailing Address - Fax:
Practice Address - Street 1:3600 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3842
Practice Address - Country:US
Practice Address - Phone:225-387-7818
Practice Address - Fax:225-381-6650
Is Sole Proprietor?:No
Enumeration Date:2011-06-25
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA/AP06549363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2162501Medicaid