# PELICAN CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740553569
- **Authorized official:** LETHA HAYNES (OWNER)
- **Authorized official phone:** (954) 492-7150

## Contact information

- **Practice address:** 948 CAMBRIDGE DR STE 103B, LA PLACE, LA 70068-3647
- **Practice address phone:** (985) 652-7717
- **Practice address fax:** (337) 896-6441
- **Mailing address:** 948 CAMBRIDGE DR STE 103B, LA PLACE, LA 70068-3647
- **Mailing address phone:** (985) 652-7717
- **Mailing address fax:** (985) 618-3611

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | 27302 | LA | Yes |

## Other

- **Enumeration date:** 02/10/2012
- **Last updated:** 04/21/2023