Healthcare Provider Details

I. General information

NPI: 1639896111
Provider Name (Legal Business Name): LISA MICHELLE LEGEAUX DNP, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4209 CANAL ST
NEW ORLEANS LA
70119-5942
US

IV. Provider business mailing address

4209 CANAL ST
NEW ORLEANS LA
70119-5942
US

V. Phone/Fax

Practice location:
  • Phone: 504-864-0800
  • Fax: 504-949-7495
Mailing address:
  • Phone: 504-864-0800
  • Fax: 504-949-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number227600
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number112261
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: