Provider Demographics
NPI:1578923249
Name:GAUTHIER, CHAD PAUL (APRN)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:PAUL
Last Name:GAUTHIER
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 1:151 DERICK ST
Mailing Address - Street 2:
Mailing Address - City:COTTONPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71327-3856
Mailing Address - Country:US
Mailing Address - Phone:318-290-4965
Mailing Address - Fax:
Practice Address - Street 1:151 DERICK ST
Practice Address - Street 2:
Practice Address - City:COTTONPORT
Practice Address - State:LA
Practice Address - Zip Code:71327-3856
Practice Address - Country:US
Practice Address - Phone:318-290-4965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN105453163W00000X
LAAP08663363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse