Healthcare Provider Details

I. General information

NPI: 1003047994
Provider Name (Legal Business Name): DR TERRELL S MANUEL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12038 GREENWELL SPRINGS PORT HUDSON ROAD
ZACHARY LA
70791
US

IV. Provider business mailing address

336 BRIGHTWOOD DR
LAFAYETTE LA
70508-7358
US

V. Phone/Fax

Practice location:
  • Phone: 225-654-1560
  • Fax:
Mailing address:
  • Phone: 337-298-8293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP04812
License Number StateLA

VIII. Authorized Official

Name: TERRELL S MANUEL
Title or Position: OWNER/PROVIDER
Credential: FNP, PMHNP, DNP
Phone: 337-298-8293