Provider Demographics
NPI:1851690812
Name:RICHE', LYNDA LANTRIP (NP)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:LANTRIP
Last Name:RICHE'
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LYNDA
Other - Middle Name:LOUISE
Other - Last Name:RICHE'
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:501 DR MICHAEL DEBAKEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5724
Mailing Address - Country:US
Mailing Address - Phone:337-312-8360
Mailing Address - Fax:337-312-6711
Practice Address - Street 1:501 DR MICHAEL DEBAKEY DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5724
Practice Address - Country:US
Practice Address - Phone:337-312-8462
Practice Address - Fax:337-312-6720
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03599363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1438243Medicaid
LAP01229746Medicare PIN
LA1438243Medicaid