Provider Demographics
NPI:1114316635
Name:LAGASSE, BRIANNE (FNP)
Entity type:Individual
Prefix:
First Name:BRIANNE
Middle Name:
Last Name:LAGASSE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1397
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-1397
Mailing Address - Country:US
Mailing Address - Phone:985-951-9932
Mailing Address - Fax:985-871-9094
Practice Address - Street 1:513 KRISTIAN CT
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-3716
Practice Address - Country:US
Practice Address - Phone:985-951-9932
Practice Address - Fax:985-871-9094
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08205363LF0000X
LARN111084363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2385461Medicaid
LA396169YJQWMedicare PIN