Provider Demographics
NPI:1952975450
Name:FALGOUT, AMY BREAUX (NP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BREAUX
Last Name:FALGOUT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 10TH ST
Mailing Address - Street 2:
Mailing Address - City:GUEYDAN
Mailing Address - State:LA
Mailing Address - Zip Code:70542-3805
Mailing Address - Country:US
Mailing Address - Phone:985-665-9369
Mailing Address - Fax:
Practice Address - Street 1:8923 BLUEBONNET BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2973
Practice Address - Country:US
Practice Address - Phone:225-766-4133
Practice Address - Fax:225-766-4135
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA218161363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily