Healthcare Provider Details

I. General information

NPI: 1497372957
Provider Name (Legal Business Name): ACADIANA PRACTITIONERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 OAK TREE PARK DR STE B
SUNSET LA
70584-6135
US

IV. Provider business mailing address

414 SAIZAN AVENUE
PORT BARRE LA
70577-5156
US

V. Phone/Fax

Practice location:
  • Phone: 337-510-5010
  • Fax: 337-585-2674
Mailing address:
  • Phone: 337-447-4027
  • Fax: 337-585-2674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DUSTIN JOSEPH MILLER
Title or Position: PRESIDENT
Credential:
Phone: 337-942-5899