Healthcare Provider Details

I. General information

NPI: 1982355152
Provider Name (Legal Business Name): LAFAYETTE HEALTH VENTURES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 WRIGHT AVE STE H
CROWLEY LA
70526-2226
US

IV. Provider business mailing address

PO BOX 919229
DALLAS TX
75391-9229
US

V. Phone/Fax

Practice location:
  • Phone: 337-785-5440
  • Fax: 337-785-5441
Mailing address:
  • Phone: 337-289-8944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY DOOLEY
Title or Position: COO
Credential:
Phone: 337-571-1394