Provider Demographics
NPI:1962443804
Name:EVITT, BERNADETTE MICHELLE (PA)
Entity Type:Individual
Prefix:MS
First Name:BERNADETTE
Middle Name:MICHELLE
Last Name:EVITT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3521 HIGHWAY 190
Mailing Address - Street 2:SUITE P
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-5135
Mailing Address - Country:US
Mailing Address - Phone:337-457-8040
Mailing Address - Fax:337-457-8043
Practice Address - Street 1:3521 HIGHWAY 190
Practice Address - Street 2:SUITE P
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-5135
Practice Address - Country:US
Practice Address - Phone:337-457-8040
Practice Address - Fax:337-457-8043
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9102708363A00000X
LAPA.200167363A00000X
LAPA200167363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant