1427615087 NPI number — LACY CAVALIER THOMAS FNP

Table of content: LACY CAVALIER THOMAS FNP (NPI 1427615087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427615087 NPI number — LACY CAVALIER THOMAS FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
LACY
Provider Middle Name:
CAVALIER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAVALIER
Provider Other First Name:
LACY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427615087
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6450 LOUISIANA HIGHWAY 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATCHELOR
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-492-3775
Provider Business Mailing Address Fax Number:
225-492-3782

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
230 ROBERTS DR STE H
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ROADS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70760-2661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-638-5879
Provider Business Practice Location Address Fax Number:
225-238-8330
Provider Enumeration Date:
05/20/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  203755 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2500520 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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