Provider Demographics
NPI:1962190439
Name:TOUPS, ALYCE JOAN (PA)
Entity type:Individual
Prefix:
First Name:ALYCE
Middle Name:JOAN
Last Name:TOUPS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BIJOU DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-8360
Mailing Address - Country:US
Mailing Address - Phone:337-288-2258
Mailing Address - Fax:
Practice Address - Street 1:105 CORPORATE BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3850
Practice Address - Country:US
Practice Address - Phone:337-593-9099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
LA337660363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant