Healthcare Provider Details

I. General information

NPI: 1811852494
Provider Name (Legal Business Name): UROGYNECOLOGY ASSOCIATES OF LAFAYETTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ALBERTSON PKWY
BROUSSARD LA
70518-4947
US

IV. Provider business mailing address

200 ALBERTSON PKWY
BROUSSARD LA
70518-4947
US

V. Phone/Fax

Practice location:
  • Phone: 337-256-5317
  • Fax: 337-256-8389
Mailing address:
  • Phone: 337-256-5317
  • Fax: 337-256-8389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NIKA VINSON
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 650-248-4695