Healthcare Provider Details

I. General information

NPI: 1154268910
Provider Name (Legal Business Name): ANNA CATHERINE LANDRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 CAMELLIA BLVD STE 101
LAFAYETTE LA
70508-7248
US

IV. Provider business mailing address

510 WHITEBARK DR
LAFAYETTE LA
70508-6362
US

V. Phone/Fax

Practice location:
  • Phone: 337-456-6892
  • Fax: 337-449-4877
Mailing address:
  • Phone: 337-962-5336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number245936
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: