Healthcare Provider Details

I. General information

NPI: 1932900255
Provider Name (Legal Business Name): MRS. SIERRA ALAYNE TITUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS SIERRA ALAYNE VIANDS

II. Dates (important events)

Enumeration Date: 03/22/2025
Last Update Date: 04/18/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 GAUSE BLVD
SLIDELL LA
70458-2987
US

IV. Provider business mailing address

9558 LAA LA WAY
DIAMONDHEAD MS
39525-4124
US

V. Phone/Fax

Practice location:
  • Phone: 985-280-2200
  • Fax:
Mailing address:
  • Phone: 304-886-2770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: