Healthcare Provider Details

I. General information

NPI: 1528640554
Provider Name (Legal Business Name): TIANNA M MORTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2390 W CONGRESS ST
LAFAYETTE LA
70506-4205
US

IV. Provider business mailing address

2390 W CONGRESS ST
LAFAYETTE LA
70506-4205
US

V. Phone/Fax

Practice location:
  • Phone: 337-261-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number341112
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number341112
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: