1770952798 NPI number — MRS. SAMANTHA LACOUR WILLIAMS NP-C

Table of content: MRS. SAMANTHA LACOUR WILLIAMS NP-C (NPI 1770952798)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770952798 NPI number — MRS. SAMANTHA LACOUR WILLIAMS NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
SAMANTHA
Provider Middle Name:
LACOUR
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LACOUR
Provider Other First Name:
SAMANTHA
Provider Other Middle Name:
LUCILLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770952798
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4176
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUMA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70361-4176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-872-5864
Provider Business Mailing Address Fax Number:
985-872-0317

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
443 HEYMANN BLVD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70503-2630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-289-8429
Provider Business Practice Location Address Fax Number:
337-289-8431
Provider Enumeration Date:
09/21/2015

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: 363LA2200X , with the licence number:  AP05645 , 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: 2423819 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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