Provider Demographics
NPI:1033292248
Name:WILLIS, TEDDI POCHE' (APRN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:TEDDI POCHE'
Middle Name:
Last Name:WILLIS
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:TEDDI
Other - Middle Name:
Other - Last Name:PERRET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:109 TURFWAY DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5609
Mailing Address - Country:US
Mailing Address - Phone:337-371-0362
Mailing Address - Fax:
Practice Address - Street 1:2305 RICHARD ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-3223
Practice Address - Country:US
Practice Address - Phone:337-892-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO3138363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1140074Medicaid
LAP26127Medicare UPIN
LA1140074Medicaid