Provider Demographics
NPI:1154506145
Name:FREYOU, LISA L (ACNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:FREYOU
Suffix:
Gender:F
Credentials:ACNP
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 4176
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70361-4176
Mailing Address - Country:US
Mailing Address - Phone:985-876-0300
Mailing Address - Fax:985-872-3017
Practice Address - Street 1:500 N LEWIS ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2046
Practice Address - Country:US
Practice Address - Phone:337-367-5200
Practice Address - Fax:337-369-3074
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN056681-AP05455363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1039306Medicaid
LA3A6436833Medicare PIN