Provider Demographics
NPI:1699253401
Name:GRADNEY, RACQUEL RAVARE (FNP)
Entity type:Individual
Prefix:MRS
First Name:RACQUEL
Middle Name:RAVARE
Last Name:GRADNEY
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 2118
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70571-2118
Mailing Address - Country:US
Mailing Address - Phone:337-594-3499
Mailing Address - Fax:
Practice Address - Street 1:1270 ATTAKAPAS DR STE 501
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6530
Practice Address - Country:US
Practice Address - Phone:337-942-9977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP10078363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily