Healthcare Provider Details

I. General information

NPI: 1780148197
Provider Name (Legal Business Name): PALLIATIVE MEDICINE OF ACADIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2019
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 JOHNSTON ST STE 260
LAFAYETTE LA
70503-3269
US

IV. Provider business mailing address

2600 JOHNSTON ST STE 260
LAFAYETTE LA
70503-3269
US

V. Phone/Fax

Practice location:
  • Phone: 337-232-1234
  • Fax: 337-232-0477
Mailing address:
  • Phone: 337-232-1234
  • Fax: 337-232-0477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: STACY MISTRIC
Title or Position: CEO
Credential:
Phone: 337-889-5364