Glenda Gravouilla Poulan, LRST

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

Practice address

330 Guilbeau Rd
Lafayette, LA 70506

Phone

(372) 475-2473

Fax

(214) 602-4526

NPI assigned

Jun 5, 2018

Last updated

Jun 13, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1528156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528848000000",
    "number": "1447742473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 GUILBEAU RD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705066914",
            "telephone_number": "337-989-0120",
            "fax_number": "214-602-4526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 GUILBEAU RD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "70506",
            "telephone_number": "372-475-2473",
            "fax_number": "214-602-4526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POULAN",
        "first_name": "GLENDA",
        "middle_name": "GRAVOUILLA",
        "credential": "LRST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-05",
        "last_updated": "2018-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172A00000X",
            "taxonomy_group": "",
            "desc": "Driver",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Felix E Potier, RPH
• Julia Caroline Potier, OT
• Marguerite Potier, CRNA
• Shanitra Angelle Potier
• Toby Brandon Potier, FNP-C
• Edie B Pourciau, ANP-BC,PMHNP-BC
• Alonzo T. Powell Sr.
• David William Powell, MD
• Nona Powell
• Brianna Threeton Powers, MS, CCC-SLP

• Developmentally Disabled Services Day Training Agency in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Developmentally Disabled Services Day Training Agency in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.