MEDICARE: REAGAN CARROLL LEBLANC PA-C

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	363A00000X	Physician Assistant
2	363A00000X	Physician Assistant	344515	LA

General Provider Information

NPI Number	:	1497573653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REAGAN CARROLL LEBLANC PA-C

Provider Business Mailing Address
First Line	:	1231 DAVID DR
Second Line	:
City	:	MORGAN CITY
State	:	LA
Zip	:	70380-1321
Country	:	US
Telephone Number	:	985-385-6390
Fax Number	:	985-385-6393

Provider Business Practice Location Address
First Line	:	1231 DAVID DR
Second Line	:
City	:	MORGAN CITY
State	:	LA
Zip	:	70380-1321
Country	:	US
Telephone Number	:	985-385-6390
Fax Number	:	985-385-6393

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2024
Last Update Date	:	01/30/2025

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