Provider Demographics
NPI:1134313331
Name:MCGOVERN, PATRICIA D (NP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:D
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:337-470-3486
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:100 ASMA BLVD BLDG 1 SUITE 205
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508
Practice Address - Country:US
Practice Address - Phone:337-470-3486
Practice Address - Fax:337-289-5609
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN047758 AP05181363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1029050Medicaid
LA1029050Medicaid
LA3A402B579Medicare PIN