NPIMap

Organization Active NPI

Prestige Primary Care PLLC

  • Adult Health Nurse Practitioner
  • Lafayette, LA
National Provider Identifier
1982087987
Registry record updated Jul 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
AP04615 Issued in LA
Legal business name
PRESTIGE PRIMARY CARE PLLC
Practice address
2851 Johnston St
Lafayette, LA 70503-3243
Phone
(337) 281-6102
Fax
(877) 866-3181
NPI assigned
Jul 8, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2015

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

Authorized official

Name
Lisa Katherine Tabor, NP
Title
Owner
Phone
(337) 804-2049

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LA2200X AP04615 LA Primary

Addresses

Primary practice location

2851 Johnston St
Lafayette, LA 70503-3243

Mailing address

2851 Johnston St
Lafayette, LA 70503-3243
Phone (337) 281-6102

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1436313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436313600000",
    "number": "1982087987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2851 JOHNSTON ST",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705033243",
            "telephone_number": "337-281-6102",
            "fax_number": "877-866-3181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2851 JOHNSTON ST",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705033243",
            "telephone_number": "337-281-6102",
            "fax_number": "877-866-3181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTIGE PRIMARY CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-08",
        "last_updated": "2015-07-08",
        "status": "A",
        "authorized_official_last_name": "TABOR",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "KATHERINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "337-804-2049",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "LA",
            "license": "AP04615",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2015; 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.