Provider Demographics
NPI:1952805053
Name:MORAN, LORE-LYNDSEY HARGRAVE (FNP-C)
Entity Type:Individual
Prefix:
First Name:LORE-LYNDSEY
Middle Name:HARGRAVE
Last Name:MORAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 OAKPARK CIR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-5856
Mailing Address - Country:US
Mailing Address - Phone:337-658-6744
Mailing Address - Fax:
Practice Address - Street 1:102 ASMA BLVD STE 112
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3843
Practice Address - Country:US
Practice Address - Phone:337-504-2332
Practice Address - Fax:337-504-4748
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09809363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPA024066OtherPRESCRIPTIVE AUTHORITY