Healthcare Provider Details

I. General information

NPI: 1386046704
Provider Name (Legal Business Name): STEPHENY SUMRALL N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 08/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 AMBASSADOR CAFFERY PKWY STE 401A
LAFAYETTE LA
70508-7265
US

IV. Provider business mailing address

4811 AMBASSADOR CAFFERY PKWY SUITE 401A
LAFAYETTE LA
70508-7265
US

V. Phone/Fax

Practice location:
  • Phone: 337-456-6523
  • Fax: 337-456-6521
Mailing address:
  • Phone: 337-456-6523
  • Fax: 601-261-5716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP09288
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP09288
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: