MEDICARE: DESTINIE LEDUFF NP

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	224989	LA
2	363L00000X	Nurse Practitioner	224989	LA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	224989	LA

General Provider Information

NPI Number	:	1679217947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESTINIE LEDUFF NP

Provider Business Mailing Address
First Line	:	16333 COLUMNS WAY APT 2107
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70817-7699
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16333 COLUMNS WAY APT 2107
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70817-7699
Country	:	US
Telephone Number	:	225-362-8199
Fax Number	:

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

Provider Enumeration Date	:	04/23/2022
Last Update Date	:	06/04/2026

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