Provider Demographics
NPI:1376311894
Name:NUGENT, STEVEN TYLER (ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:TYLER
Last Name:NUGENT
Suffix:
Gender:M
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 PINEY CV
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7461
Mailing Address - Country:US
Mailing Address - Phone:318-914-3279
Mailing Address - Fax:
Practice Address - Street 1:1616 WELLERMAN RD
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7427
Practice Address - Country:US
Practice Address - Phone:318-387-2577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA233661363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care