Healthcare Provider Details

I. General information

NPI: 1780054221
Provider Name (Legal Business Name): ACADIANA AFTER HOURS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2015
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 ODD FELLOWS RD
CROWLEY LA
70526-2204
US

IV. Provider business mailing address

155 ODD FELLOWS RD
CROWLEY LA
70526-2204
US

V. Phone/Fax

Practice location:
  • Phone: 337-514-5200
  • Fax: 337-514-2151
Mailing address:
  • Phone: 337-514-5200
  • Fax: 337-514-2151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GERONNA LEONARDS
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 337-514-5200