Healthcare Provider Details

I. General information

NPI: 1255811659
Provider Name (Legal Business Name): LAGNIAPPE MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 GREENBRIER BLVD
COVINGTON LA
70433-7236
US

IV. Provider business mailing address

PO BOX 957
MADISONVILLE LA
70447-0957
US

V. Phone/Fax

Practice location:
  • Phone: 985-771-2221
  • Fax:
Mailing address:
  • Phone: 985-771-2221
  • Fax: 844-713-8349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ATNENA LUSTER
Title or Position: OWNER
Credential: NP
Phone: 985-771-2221