Healthcare Provider Details

I. General information

NPI: 1497189088
Provider Name (Legal Business Name): YENEY GAGNARD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2013
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W. ST. MARY BLVD STE. 110
LAFAYETTE LA
70506
US

IV. Provider business mailing address

PO BOX 53069
LAFAYETTE LA
70505
US

V. Phone/Fax

Practice location:
  • Phone: 337-233-8887
  • Fax: 337-233-4442
Mailing address:
  • Phone: 954-442-8380
  • Fax: 954-442-8661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPAT9107417
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number305875
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: