Healthcare Provider Details

I. General information

NPI: 1881480762
Provider Name (Legal Business Name): ALAINA RENEE LANDRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 N VAUGHAN DR
BRUSLY LA
70719-2217
US

IV. Provider business mailing address

6450 LA HIGHWAY 1 STE B
BATCHELOR LA
70715-3212
US

V. Phone/Fax

Practice location:
  • Phone: 225-344-0008
  • Fax:
Mailing address:
  • Phone: 225-618-5015
  • Fax: 225-442-3107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number348363
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: