Healthcare Provider Details

I. General information

NPI: 1215200910
Provider Name (Legal Business Name): MRS. ALICIA ANN MORGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2012
Last Update Date: 02/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W SAINT MARY BLVD SUITE 308
LAFAYETTE LA
70506-3568
US

IV. Provider business mailing address

900 LEBLANC RD LOT 65
DUSON LA
70529-4440
US

V. Phone/Fax

Practice location:
  • Phone: 337-235-8007
  • Fax: 337-235-8008
Mailing address:
  • Phone: 337-288-0635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number112953
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: