1104080084 NPI number — MRS. ASHLEY BLAIR LANDRY M.A.

Table of content: MRS. ASHLEY BLAIR LANDRY M.A. (NPI 1104080084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104080084 NPI number — MRS. ASHLEY BLAIR LANDRY M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANDRY
Provider First Name:
ASHLEY
Provider Middle Name:
BLAIR
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LANDRY
Provider Other First Name:
BLAIR
Provider Other Middle Name:
H.
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1104080084
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4451 BLUEBONNET BLVD, STE G
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-663-6130
Provider Business Mailing Address Fax Number:
225-757-6559

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4451 BLUEBONNET BLVD
Provider Second Line Business Practice Location Address:
STE G
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-663-6130
Provider Business Practice Location Address Fax Number:
225-757-6559
Provider Enumeration Date:
07/10/2008

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: 231H00000X , with the licence number:  5262 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: 5262 , 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)





Copyright © 2007-2025 www.npivalidator.com