Provider Demographics
NPI:1629691530
Name:BAYOU PEDIATRICS
Entity Type:Organization
Organization Name:BAYOU PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:318-376-0275
Mailing Address - Street 1:150 HATTAWAY RD
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:LA
Mailing Address - Zip Code:71225-8541
Mailing Address - Country:US
Mailing Address - Phone:318-376-0275
Mailing Address - Fax:
Practice Address - Street 1:2649 ARKANSAS RD
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-8617
Practice Address - Country:US
Practice Address - Phone:318-376-0275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty