Individual provider Active NPI

Morgan Anne Mannina-Williams, PA-C

  • Medical Physician Assistant
  • Lafayette, LA
National Provider Identifier
1265623722
Registry record updated May 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA.TEMP.PERMIT Issued in LA
Practice address
1103 Kaliste Saloom Rd Ste 100
Lafayette, LA 70508-5784
Phone
(337) 234-5234
Fax
(337) 210-5367
NPI assigned
Aug 8, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA.TEMP.PERMIT LA Primary

Addresses

Primary practice location

1103 Kaliste Saloom Rd Ste 100
Lafayette, LA 70508-5784

Mailing address

1103 Kaliste Saloom Rd Ste 100
Lafayette, LA 70508-5784
Phone (337) 234-5234

Other practice location 1

500 S 6th St
Leesville, LA 71446-4442
Phone (337) 239-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20080627000295 LA Practitioner - Physician Assistant 8123108586 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jayme Trahan, MD Professional Limited Liability CompanyGroup PAC ID 1759503675, 3 clinicians

Practice addresses (Care Compare)

1103 Kaliste Saloom Rd
Suite 100
Lafayette, LA 70508-5784
Phone (337) 267-1355

Hospital & facility affiliations

  • Lafayette Surgical Specialty Hospital Hospital, Lafayette, LA, CCN 190259

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA.TEMP.PERMITLAMDPhysician Assistant

Organizations & group practices 1

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 2

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": "1186531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589241600000",
    "number": "1265623722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1103 KALISTE SALOOM RD STE 100",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705085784",
            "telephone_number": "337-234-5234",
            "fax_number": "337-210-5367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 KALISTE SALOOM RD STE 100",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705085784",
            "telephone_number": "337-234-5234",
            "fax_number": "337-210-5367"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 S 6th St",
            "address_purpose": "LOCATION",
            "city": "Leesville",
            "state": "LA",
            "postal_code": "714464442",
            "country_code": "US",
            "telephone_number": "337-239-8000",
            "fax_number": "337-239-8003",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANNINA-WILLIAMS",
        "first_name": "MORGAN",
        "middle_name": "ANNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-08",
        "last_updated": "2020-05-12",
        "certification_date": "2020-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "LA",
            "license": "PA.TEMP.PERMIT",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, LA

Sources for this page

Verify at the official NPI Registry.