Healthcare Provider Details

I. General information

NPI: 1942663885
Provider Name (Legal Business Name): AUNDRIA HEBERT CANNON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 HEYMANN BLVD
LAFAYETTE LA
70503-2616
US

IV. Provider business mailing address

155 HOSPITAL DR STE 410
LAFAYETTE LA
70503-2852
US

V. Phone/Fax

Practice location:
  • Phone: 337-234-3344
  • Fax: 337-234-3352
Mailing address:
  • Phone: 337-235-4460
  • Fax: 337-235-3060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP08713
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: