Provider Demographics
NPI:1417262361
Name:PECH, CASEY DUFRENE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:DUFRENE
Last Name:PECH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 N VICTOR II BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1392
Mailing Address - Country:US
Mailing Address - Phone:985-702-2229
Mailing Address - Fax:985-384-0329
Practice Address - Street 1:406 N ACADIA RD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4856
Practice Address - Country:US
Practice Address - Phone:859-446-2890
Practice Address - Fax:985-446-2189
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN084493 AP06207363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2129783Medicaid