Healthcare Provider Details

I. General information

NPI: 1215841861
Provider Name (Legal Business Name): FANCY PANTS SPA & BEAUTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 DOUCET RD STE B1
LAFAYETTE LA
70503-3403
US

IV. Provider business mailing address

233 DOUCET RD STE B1
LAFAYETTE LA
70503-3403
US

V. Phone/Fax

Practice location:
  • Phone: 337-984-9972
  • Fax:
Mailing address:
  • Phone: 337-984-9972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: STEPHANIE M HANKS
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 804-724-1618