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General NPI Number Information
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NPI Number | 1003047994
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Entity Type | Organization
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Legal Business Name | DR TERRELL S MANUEL LLC
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Dates
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Enumeration Date | 07/27/2009
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Last Update Date | 10/18/2019
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Provider Practice Location Address
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Address Line | 12038 GREENWELL SPRINGS PORT HUDSON ROAD
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City | ZACHARY
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State | LA
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Zip | 70791
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Country | US
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Telephone | 225-654-1560
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 82570
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City | LAFAYETTE
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State | LA
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Zip | 70598-2570
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Country | US
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Telephone | 337-298-8293
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DR. TERRELL S MANUEL
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Credential | DNP, APRN, FNP, PMHN
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Telephone | 337-298-8293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP04812
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License Number State | LA
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