Healthcare Provider Details

I. General information

NPI: 1306096854
Provider Name (Legal Business Name): MDHPX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2008
Last Update Date: 09/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1257 MAYEAUXVILLE RD
VILLE PLATTE LA
70586-8409
US

IV. Provider business mailing address

1257 MAYEAUXVILLE RD
VILLE PLATTE LA
70586-8409
US

V. Phone/Fax

Practice location:
  • Phone: 337-363-0456
  • Fax: 337-363-2489
Mailing address:
  • Phone: 337-363-0456
  • Fax: 337-363-2489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number023604
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number05182
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number04414
License Number StateLA

VIII. Authorized Official

Name: KRISTINA G LANDRY
Title or Position: CO-OWNER
Credential: F.N.P.
Phone: 337-363-0456