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General NPI Number Information
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NPI Number | 1841560034
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Entity Type | Individual
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Provider Name | COURTNEY M HERNANDEZ PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/05/2012
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 660 FACTORY OUTLET DR
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City | ARCADIA
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State | LA
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Zip | 71001-3036
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Country | US
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Telephone | 318-816-8155
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Fax | 318-782-7055
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Provider Business Mailing Address
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Address Line | 5520 JOHNSTON ST STE K
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City | LAFAYETTE
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State | LA
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Zip | 70503-5138
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Country | US
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Telephone | 318-816-8155
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Fax | 318-782-7055
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA200508
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License Number State | LA
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