Healthcare Provider Details

I. General information

NPI: 1265095004
Provider Name (Legal Business Name): VESTRA HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

287 PANTHER TRAIL DRIVE
KINDER LA
70648
US

IV. Provider business mailing address

218 ENGLISH GARDENS PKWY
LAFAYETTE LA
70503-5680
US

V. Phone/Fax

Practice location:
  • Phone: 337-738-4180
  • Fax: 337-738-4179
Mailing address:
  • Phone: 337-884-8799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL J BOUDREAUX
Title or Position: CEO
Credential:
Phone: 337-884-8799