=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881480762
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALAINA RENEE LANDRY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2025
-----------------------------------------------------
Last Update Date | 08/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8569 FOXFIELD DR
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70809-5211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-771-9757
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6450 LA HIGHWAY 1
-----------------------------------------------------
City | BATCHELOR
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70715-3212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-771-9757
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------