Healthcare Provider Details

I. General information

NPI: 1023775475
Provider Name (Legal Business Name): DIABETES RELIEF OF ACADIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 CAMELLIA BLVD STE 100
LAFAYETTE LA
70508-7220
US

IV. Provider business mailing address

1223 CAMELLIA BLVD STE 100
LAFAYETTE LA
70508-7220
US

V. Phone/Fax

Practice location:
  • Phone: 337-270-9093
  • Fax: 337-270-9094
Mailing address:
  • Phone: 337-270-9093
  • Fax: 337-270-9094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMIE HOLMES
Title or Position: MANAGING EMPLOYEE
Credential:
Phone: 337-962-2488