Healthcare Provider Details

I. General information

NPI: 1346827391
Provider Name (Legal Business Name): NP MED OF ACADIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 AMBASSADOR CAFFERY PKWY FL 4
LAFAYETTE LA
70508-7265
US

IV. Provider business mailing address

207 SANDBAR LN
LAFAYETTE LA
70508-7263
US

V. Phone/Fax

Practice location:
  • Phone: 305-322-5100
  • Fax:
Mailing address:
  • Phone: 305-832-2510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KEIFFER BENGIE WYBLE
Title or Position: SOLE OWNER
Credential: APRN, NP
Phone: 305-322-5100