Healthcare Provider Details

I. General information

NPI: 1588153159
Provider Name (Legal Business Name): LASHUNDA BRAXTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7569 E INDUSTRIAL DR
BATON ROUGE LA
70805-7518
US

IV. Provider business mailing address

PO BOX 45698
BATON ROUGE LA
70895-4698
US

V. Phone/Fax

Practice location:
  • Phone: 225-924-9164
  • Fax: 225-924-5479
Mailing address:
  • Phone: 225-924-9164
  • Fax: 225-924-5479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: