Provider Demographics
NPI:1679464556
Name:ACOSTA, MARY ANN
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 CAMILLE DR LOT A
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70392-4111
Mailing Address - Country:US
Mailing Address - Phone:337-940-3399
Mailing Address - Fax:
Practice Address - Street 1:342 CAMILLE DR LOT A
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:LA
Practice Address - Zip Code:70392-4111
Practice Address - Country:US
Practice Address - Phone:337-940-3399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care