Provider Demographics
NPI:1477103240
Name:PEPERONE, ANTHONY MICHEAL (APRN)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:MICHEAL
Last Name:PEPERONE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4430 HIGHWAY 22 STE B
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3310
Mailing Address - Country:US
Mailing Address - Phone:985-626-3470
Mailing Address - Fax:985-674-5377
Practice Address - Street 1:4430 HIGHWAY 22 STE B
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3310
Practice Address - Country:US
Practice Address - Phone:985-626-3470
Practice Address - Fax:985-674-5377
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3044962084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine