Provider Demographics
NPI:1861766206
Name:LANDRY, MATT JUDE (NP)
Entity type:Individual
Prefix:MR
First Name:MATT
Middle Name:JUDE
Last Name:LANDRY
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:PO BOX 4176
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70361-4176
Mailing Address - Country:US
Mailing Address - Phone:985-872-5864
Mailing Address - Fax:985-872-0317
Practice Address - Street 1:443 HEYMANN BLVD
Practice Address - Street 2:STE. B
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2630
Practice Address - Country:US
Practice Address - Phone:337-289-8429
Practice Address - Fax:337-289-8431
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2017-03-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAAP06784363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2193601Medicaid
LA274716YJQDMedicare PIN
LA274716YJQDMedicare PIN