| Lake Professionals Llc | |
|
501 W Saint Mary Blvd Ste 210 Lafayette LA 70506-4699 | |
| (337) 233-1114 | |
| Not Available |
| Full Name | Lake Professionals Llc |
|---|---|
| Speciality | General Practice |
| Location | 501 W Saint Mary Blvd Ste 210, Lafayette, Louisiana |
| Authorized Official Name and Position | Douglass H Perret (CEO) |
| Authorized Official Contact | 3372331114 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Professionals Llc Po Box 53388 Lafayette LA 70505-3388 Ph: (337) 233-1114 | Lake Professionals Llc 501 W Saint Mary Blvd Ste 210 Lafayette LA 70506-4699 Ph: (337) 233-1114 |
| NPI Number | 1497313670 |
|---|---|
| Provider Enumeration Date | 06/03/2019 |
| Last Update Date | 04/25/2023 |
| Medicare PECOS PAC ID | 8224494166 |
|---|---|
| Medicare Enrollment ID | O20230518000653 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497313670 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | William G Rasberry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891020129 PECOS PAC ID: 4587703640 Enrollment ID: I20091202000489 |
| Provider Name | Joan Elizabeth Brunson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184616112 PECOS PAC ID: 7618020371 Enrollment ID: I20100614000710 |
| Provider Name | Jacqueline A Schexnyder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477537066 PECOS PAC ID: 4981884103 Enrollment ID: I20110204000824 |
| Provider Name | Wayne D Foster |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740626225 PECOS PAC ID: 7911157664 Enrollment ID: I20130815000092 |
| Provider Name | Christopher J Rodgman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861635849 PECOS PAC ID: 1658662812 Enrollment ID: I20160617000696 |
| Provider Name | Mandie Michelle Haggart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821661430 PECOS PAC ID: 0042608986 Enrollment ID: I20211027000400 |
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