Healthcare Provider Details

I. General information

NPI: 1528099769
Provider Name (Legal Business Name): KATIE C TRAHAN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 RUE LOUIS XIV
LAFAYETTE LA
70508-5739
US

IV. Provider business mailing address

108 RUE LOUIS XIV
LAFAYETTE LA
70508-5739
US

V. Phone/Fax

Practice location:
  • Phone: 337-235-8007
  • Fax: 337-235-8008
Mailing address:
  • Phone: 337-235-8007
  • Fax: 337-235-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN097536
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: