Healthcare Provider Details

I. General information

NPI: 1922566934
Provider Name (Legal Business Name): LOUISIANA STATE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2019
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 PERKINS RD
BATON ROUGE LA
70808-0102
US

IV. Provider business mailing address

6400 PERKINS RD
BATON ROUGE LA
70808-0102
US

V. Phone/Fax

Practice location:
  • Phone: 225-763-3101
  • Fax: 225-763-3102
Mailing address:
  • Phone: 225-763-3101
  • Fax: 225-763-3102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: GUY JOEL LAVERGNE
Title or Position: CFO/COO
Credential:
Phone: 225-763-3101