Healthcare Provider Details

I. General information

NPI: 1538096763
Provider Name (Legal Business Name): CODY MCNEIL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20097 TWIN OAKS DR
HAMMOND LA
70403-0422
US

IV. Provider business mailing address

20097 TWIN OAKS DR
HAMMOND LA
70403-0422
US

V. Phone/Fax

Practice location:
  • Phone: 504-390-1373
  • Fax:
Mailing address:
  • Phone: 504-390-1373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number25254285
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: