Provider Demographics
NPI:1619977824
Name:POURCIAU, CATHERINE ANN (NP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN
Last Name:POURCIAU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-526-0006
Mailing Address - Fax:225-765-9291
Practice Address - Street 1:6516 E MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-4348
Practice Address - Country:US
Practice Address - Phone:225-774-7320
Practice Address - Fax:225-774-5432
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA374772031363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1543713Medicaid
LA1543713Medicaid
LA5X589DD21Medicare PIN
LA5X589Medicare PIN