Healthcare Provider Details

I. General information

NPI: 1043146731
Provider Name (Legal Business Name): SHANIE RANKIN FARNSWORTH RPSGT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ASMA BLVD STE 205
LAFAYETTE LA
70508-3842
US

IV. Provider business mailing address

100 PROVIDENCE CT
LAFAYETTE LA
70506-6609
US

V. Phone/Fax

Practice location:
  • Phone: 337-470-3486
  • Fax:
Mailing address:
  • Phone: 337-967-3289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberPOLY.000316
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: