Provider Demographics
NPI:1982164620
Name:DOUMIT, LAUREN BACON (ACNPC-AG)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:BACON
Last Name:DOUMIT
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:NICOLE
Other - Last Name:BACON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNPC-AG
Mailing Address - Street 1:531A JEFFERSON TER
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-4949
Mailing Address - Country:US
Mailing Address - Phone:337-560-0880
Mailing Address - Fax:337-560-0870
Practice Address - Street 1:531A JEFFERSON TER
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4949
Practice Address - Country:US
Practice Address - Phone:337-560-0880
Practice Address - Fax:337-560-0870
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP204131363L00000X, 364SR0400X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No364SR0400XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistRehabilitationGroup - Single Specialty