1760743058 NPI number — MRS. LACI HUCKABY BYRNE APRN, ANP

Table of content: HYUNG J KIM MD (NPI 1003076761)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760743058 NPI number — MRS. LACI HUCKABY BYRNE APRN, ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BYRNE
Provider First Name:
LACI
Provider Middle Name:
HUCKABY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, ANP
Provider Gender Code:
F

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1760743058
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1322 ELTON RD
Provider Second Line Business Mailing Address:
SUITE F
Provider Business Mailing Address City Name:
JENNINGS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70546-4100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-824-8868
Provider Business Mailing Address Fax Number:
337-824-8840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1322 ELTON RD
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
JENNINGS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70546-4100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-824-8868
Provider Business Practice Location Address Fax Number:
337-824-8840
Provider Enumeration Date:
06/03/2012

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:  AP06820 , 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: 2336801 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com