Provider Demographics
NPI:1477551612
Name:STEVENS, NICHOLAS C (PHD MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:C
Last Name:STEVENS
Suffix:
Gender:M
Credentials:PHD MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1799
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-1799
Mailing Address - Country:US
Mailing Address - Phone:985-542-6251
Mailing Address - Fax:985-945-2386
Practice Address - Street 1:42388 PELICAN PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403
Practice Address - Country:US
Practice Address - Phone:985-542-6251
Practice Address - Fax:985-945-2386
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA015218207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2705080004OtherCIGNA HEALTHCARE OF LA
LA1198706Medicaid
LA4250496OtherAETNA US HEALTHCARE
B65723Medicare UPIN
LA4250496OtherAETNA US HEALTHCARE