Healthcare Provider Details

I. General information

NPI: 1407520463
Provider Name (Legal Business Name): TABITHA D LUKE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 RIDGEFIELD RD
THIBODAUX LA
70301-4333
US

IV. Provider business mailing address

1115 WEBER ST
FRANKLIN LA
70538-4124
US

V. Phone/Fax

Practice location:
  • Phone: 985-446-7341
  • Fax:
Mailing address:
  • Phone: 337-828-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number221523
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number221523
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: