Basic Information
| Provider Information | |||||||||
| NPI: | 1548513120 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEGER | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | CLAIRE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 131 N 9TH ST | ||||||||
| Address2: | |||||||||
| City: | EUNICE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705353103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3375806242 | ||||||||
| FaxNumber: | 7708745483 | ||||||||
| Practice Location | |||||||||
| Address1: | 1214 COOLIDGE BLVD | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705032621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372897529 | ||||||||
| FaxNumber: | 3372897190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2012 | ||||||||
| LastUpdateDate: | 10/19/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA.200562 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.