Healthcare Provider Details

I. General information

NPI: 1427425107
Provider Name (Legal Business Name): MICHELLE W DUMESTRE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 ASMA BLVD BUILDING 3, SUITE 112
LAFAYETTE LA
70508-3846
US

IV. Provider business mailing address

91 SETTLERS TRACE BLVD STE 3
LAFAYETTE LA
70508-6090
US

V. Phone/Fax

Practice location:
  • Phone: 337-504-2332
  • Fax: 337-504-4748
Mailing address:
  • Phone: 337-524-1700
  • Fax: 337-524-1702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: