Provider Demographics
NPI:1528481587
Name:MYERS, ELLIOT
Entity type:Individual
Prefix:
First Name:ELLIOT
Middle Name:
Last Name:MYERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 SANDERS STREET
Mailing Address - Street 2:
Mailing Address - City:PINE PRAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70543-0736
Mailing Address - Country:US
Mailing Address - Phone:337-599-2850
Mailing Address - Fax:337-599-2852
Practice Address - Street 1:1015 SANDERS STREET
Practice Address - Street 2:
Practice Address - City:PINE PRAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70576-0736
Practice Address - Country:US
Practice Address - Phone:337-599-2850
Practice Address - Fax:337-599-2852
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07654363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health