Healthcare Provider Details

I. General information

NPI: 1386306538
Provider Name (Legal Business Name): AMANDA R LAVIGNE APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7039 HIGHWAY 190 EAST SERVICE RD
COVINGTON LA
70433-4961
US

IV. Provider business mailing address

67252 INDUSTRY LN
COVINGTON LA
70433-8704
US

V. Phone/Fax

Practice location:
  • Phone: 985-338-2620
  • Fax: 985-338-2621
Mailing address:
  • Phone: 985-809-9888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number222047
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: