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General NPI Number Information
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NPI Number | 1255156113
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Entity Type | Organization
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Legal Business Name | LAKE CRESCENT HEALTH LLC
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 301 NORTH MAIN STREET SUITE 2200
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City | BATON ROUGE
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State | LA
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Zip | 70801
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Country | US
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Telephone | 504-319-6078
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Fax | 225-644-6013
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Provider Business Mailing Address
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Address Line | PO BOX 82
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City | SORRENTO
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State | LA
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Zip | 70778-0082
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Country | US
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Telephone | 225-831-6111
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Fax | 225-644-6013
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Authorized Official
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Title or Position | OWNER
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Name | LAKEISHA MACK LONG
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Credential | FNP-BC
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Telephone | 225-831-6111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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