Provider Demographics
NPI:1538539739
Name:PRUDHOMME, LYDIA
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:PRUDHOMME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:SIMSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71275-3120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:107 W ALABAMA AVE
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-4403
Practice Address - Country:US
Practice Address - Phone:318-224-7170
Practice Address - Fax:318-224-7063
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator