Healthcare Provider Details

I. General information

NPI: 1245763762
Provider Name (Legal Business Name): MARTHA LANDRY EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARTHA MARIE LANDRY NURSE PRACTITIONER

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 N ARDENWOOD DR APT 104
BATON ROUGE LA
70806-2053
US

IV. Provider business mailing address

385 S 11TH ST
BATON ROUGE LA
70802-4733
US

V. Phone/Fax

Practice location:
  • Phone: 225-571-5719
  • Fax:
Mailing address:
  • Phone: 225-284-1708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP09271
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP09271
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: