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NPI Code Detail

MEDICARE: MRS. TIA LEA TRAHAN PA-C

MEDICARE: MRS. TIA LEA TRAHAN 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
1363AM0700XMedical Physician Assistant343273LA

General Provider Information

NPI Number : 1588008627
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TIA LEA TRAHAN PA-C
Provider Business Mailing Address
First Line : 148 WALL BLVD
Second Line :
City : GRETNA
State : LA
Zip : 70056-7107
Country : US
Telephone Number : 504-393-2273
Fax Number :
Provider Business Practice Location Address
First Line : 148 WALL BLVD
Second Line :
City : GRETNA
State : LA
Zip : 70056-7107
Country : US
Telephone Number : 504-393-2273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2013
Last Update Date : 11/24/2025

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