Provider Demographics
NPI:1932789278
Name:PEDEN, ALANA CHRISTINE (LPN)
Entity type:Individual
Prefix:
First Name:ALANA
Middle Name:CHRISTINE
Last Name:PEDEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3871 TEXAS EASTERN RD
Mailing Address - Street 2:
Mailing Address - City:RAGLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70657-6404
Mailing Address - Country:US
Mailing Address - Phone:337-405-8833
Mailing Address - Fax:
Practice Address - Street 1:330 ALAMO ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8584
Practice Address - Country:US
Practice Address - Phone:337-475-0324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA20180458164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse