Individual provider Active NPI

Nikki Clary Leglue, PA-C

  • Physician Assistant
  • Lafayette, LA
National Provider Identifier
1144556622
Registry record updated Jun 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.200293 Issued in LA
Practice address
4600 Ambassador Caffery Pkwy
Lafayette, LA 70508-6902
Phone
(337) 521-9100
NPI assigned
Oct 19, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA.200293 LA Primary

Addresses

Primary practice location

4600 Ambassador Caffery Pkwy
Lafayette, LA 70508-6902

Mailing address

4600 Ambassador Caffery Pkwy
Lafayette, LA 70508-6902
Phone (337) 521-9100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA, MS2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20091219000094 LA Practitioner - Physician Assistant 5294875498 Reassigns benefits to 4 organizations
I20240912003577 MS Practitioner - Physician Assistant 5294875498 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Skylink Medical IncGroup PAC ID 0143611640, 7 clinicians

Practice addresses (Care Compare)

1822 15TH St
Suite B
Gulfport, MS 39501-2104
Phone (337) 349-6655

224 Saint Landry St
Suite 1G
Lafayette, LA 70506-3549
Phone (337) 349-6655

4400 A Ambassador Caffery Pkwy
Suite 190
Lafayette, LA 70508-6760

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA.200293LAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Hulin Urgent Care Services LLC CurrentSince Sep 1, 2015 Accepting new patients
Hulin Urgent Care Services LLC CurrentSince Sep 1, 2015 Accepting new patients

Locations

1110 E Saint Peter St
New Iberia, LA 70560
Phone (337) 364-1166

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/25308/brand/1/csg/1/fhir/r4
  • Direct secure messaging: nikki.leglue.1@25308.direct.athenahealth.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1255910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403222400000",
    "number": "1144556622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 AMBASSADOR CAFFERY PKWY",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705086902",
            "telephone_number": "337-521-9100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 AMBASSADOR CAFFERY PKWY",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705086902",
            "telephone_number": "337-521-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEGLUE",
        "first_name": "NIKKI",
        "middle_name": "CLARY",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-19",
        "last_updated": "2014-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "PA.200293",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, LA

Sources for this page

Verify at the official NPI Registry.