Healthcare Provider Details

I. General information

NPI: 1306769898
Provider Name (Legal Business Name): AMANDA CHARLENE LACAZE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 JACKSON ST EXT STE C355
ALEXANDRIA LA
71303-2555
US

IV. Provider business mailing address

8403 TWIN BRIDGES RD
ELMER LA
71424-9772
US

V. Phone/Fax

Practice location:
  • Phone: 318-528-5131
  • Fax:
Mailing address:
  • Phone: 318-794-5320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number152384
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: