Provider Demographics
NPI:1316402969
Name:LEGENDRE, MEGAN NEAL (APRN-CNP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:NEAL
Last Name:LEGENDRE
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 TETREAU ST
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-3537
Mailing Address - Country:US
Mailing Address - Phone:985-859-9428
Mailing Address - Fax:
Practice Address - Street 1:147 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:RESERVE
Practice Address - State:LA
Practice Address - Zip Code:70084-6001
Practice Address - Country:US
Practice Address - Phone:985-536-2605
Practice Address - Fax:985-536-8388
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA203696363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner