Provider Demographics
NPI:1679806178
Name:CHILDRENS CLINIC OF ACADIANA LLC
Entity type:Organization
Organization Name:CHILDRENS CLINIC OF ACADIANA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:APRN, FNP, OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:AMELIA
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-BC
Authorized Official - Phone:337-280-4287
Mailing Address - Street 1:850 N PIERCE ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-2848
Mailing Address - Country:US
Mailing Address - Phone:337-237-3501
Mailing Address - Fax:337-504-4623
Practice Address - Street 1:850 N PIERCE ST
Practice Address - Street 2:SUITE F
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-2848
Practice Address - Country:US
Practice Address - Phone:337-237-3501
Practice Address - Fax:337-504-4623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04543261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care