MEDICARE: MORGAN DOUCET THOMAS PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	236027	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	99-3552935	OTHER	LA	LLC

General Provider Information

NPI Number	:	1649013541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN DOUCET THOMAS PMHNP

Provider Business Mailing Address
First Line	:	PO BOX 82493
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70598-2493
Country	:	US
Telephone Number	:	337-852-4255
Fax Number	:

Provider Business Practice Location Address
First Line	:	709 SAINT JOHN ST
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70501-6705
Country	:	US
Telephone Number	:	337-409-6815
Fax Number	:

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

Provider Enumeration Date	:	06/17/2024
Last Update Date	:	11/04/2024

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