Provider Demographics
NPI:1326564089
Name:RYAN, ALLIE LACOMB (FNPC)
Entity type:Individual
Prefix:
First Name:ALLIE
Middle Name:LACOMB
Last Name:RYAN
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 EMERALD SANDS LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5266
Mailing Address - Country:US
Mailing Address - Phone:337-692-0836
Mailing Address - Fax:
Practice Address - Street 1:105 EMERALD SANDS LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5266
Practice Address - Country:US
Practice Address - Phone:337-692-0836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09174363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily