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General NPI Number Information
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NPI Number | 1679518823
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Entity Type | Individual
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Provider Name | MARK J LANDRY NP
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Gender | Male
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 02/17/2023
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Provider Practice Location Address
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Address Line | 3621 AMBASSADOR CAFFERY PKWY STE 100
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City | LAFAYETTE
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State | LA
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Zip | 70503-5132
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Country | US
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Telephone | 337-534-4410
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Fax |
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Provider Business Mailing Address
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Address Line | 2851 JOHNSTON ST
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City | LAFAYETTE
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State | LA
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Zip | 70503-3243
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Country | US
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Telephone | 337-456-3519
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Fax | 337-534-4426
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | RN095042
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP04519
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License Number State | LA
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