MEDICARE: ACADIA FAMILY CLINIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0390699-22	LA
2	261QR1300X	Rural Health Clinic/Center	133	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174710685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACADIA FAMILY CLINIC LLC

Provider Business Mailing Address
First Line	:	1325 WRIGHT AVE
Second Line	:	SUITE E
City	:	CROWLEY
State	:	LA
Zip	:	70526-2226
Country	:	US
Telephone Number	:	337-788-1081
Fax Number	:	337-788-1083

Provider Business Practice Location Address
First Line	:	1325 WRIGHT AVE
Second Line	:	SUITE E
City	:	CROWLEY
State	:	LA
Zip	:	70526-2226
Country	:	US
Telephone Number	:	337-788-1081
Fax Number	:	337-788-1083

Authorized Official
Title or Position	:	NURSE PRACTIONER/OWNER
Name	:	GINA L MILLER
Credential	:	N.P.
Telephone Number	:	337-788-1081

Provider Enumeration Date	:	09/28/2007
Last Update Date	:	01/03/2017

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