Provider Demographics
NPI:1497573653
Name:LEBLANC, REAGAN CARROLL (PA-C)
Entity type:Individual
Prefix:
First Name:REAGAN
Middle Name:CARROLL
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 DAVID DR
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1321
Mailing Address - Country:US
Mailing Address - Phone:985-385-6390
Mailing Address - Fax:985-385-6393
Practice Address - Street 1:1231 DAVID DR
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1321
Practice Address - Country:US
Practice Address - Phone:985-385-6390
Practice Address - Fax:985-385-6393
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
LA344515363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant