Provider Demographics
NPI:1336138692
Name:DESHOTELS, NATALIE (PA)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:DESHOTELS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 HEYMANN BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2632
Mailing Address - Country:US
Mailing Address - Phone:337-234-4535
Mailing Address - Fax:337-235-4272
Practice Address - Street 1:443 HEYMANN BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2632
Practice Address - Country:US
Practice Address - Phone:337-234-4535
Practice Address - Fax:337-235-4272
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA10399363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5B683P811Medicare PIN
LAP22734Medicare UPIN
LA1720053630Medicare NSC