Provider Demographics
NPI:1659557940
Name:POURCIAU, EDIE B (PMHNP-NP, ANP-BC)
Entity Type:Individual
Prefix:
First Name:EDIE
Middle Name:B
Last Name:POURCIAU
Suffix:
Gender:F
Credentials:PMHNP-NP, ANP-BC
Other - Prefix:
Other - First Name:EDIE
Other - Middle Name:B
Other - Last Name:BOUDREAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-NP, ANP-BC
Mailing Address - Street 1:PO BOX 9227
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70562-9227
Mailing Address - Country:US
Mailing Address - Phone:337-608-9922
Mailing Address - Fax:337-608-9933
Practice Address - Street 1:124 E MAIN ST
Practice Address - Street 2:STE. 104
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560
Practice Address - Country:US
Practice Address - Phone:337-608-9922
Practice Address - Fax:337-608-9933
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN102783163W00000X
LAAP05466363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2515256OtherAETNA
LA11849024OtherCAQH
LA1309877Medicaid
LA2515256OtherAETNA
LA1309877Medicaid