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NPI Code Detail

MEDICARE: MEREDITH BOUSTANY MANAFI PA-C

MEDICARE: MEREDITH BOUSTANY MANAFI PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant303565LA

General Provider Information

NPI Number : 1427505577
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEREDITH BOUSTANY MANAFI PA-C
Provider Business Mailing Address
First Line : 604 N ACADIA RD STE 101
Second Line :
City : THIBODAUX
State : LA
Zip : 70301-4897
Country : US
Telephone Number : 985-446-5079
Fax Number : 985-447-2497
Provider Business Practice Location Address
First Line : 100 PHOENIX DR
Second Line :
City : ABBEVILLE
State : LA
Zip : 70510-2396
Country : US
Telephone Number : 337-898-3700
Fax Number : 337-898-3702
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2016
Last Update Date : 03/14/2024

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Directions to “ MEREDITH BOUSTANY MANAFI PA-C” Practice Location

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