Healthcare Provider Details

I. General information

NPI: 1881117794
Provider Name (Legal Business Name): 5XY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2017
Last Update Date: 05/09/2018
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:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ATNENA LUSTER
Title or Position: OWNER
Credential: DNP, FNP
Phone: 985-771-2221