Provider Demographics
NPI:1972906964
Name:BORDELON, REBEKAH JULEE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:REBEKAH
Middle Name:JULEE
Last Name:BORDELON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 EVANGELINE HWY
Mailing Address - Street 2:
Mailing Address - City:BASILE
Mailing Address - State:LA
Mailing Address - Zip Code:70515-3332
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 CORPORATE BLVD
Practice Address - Street 2:STE 201
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3870
Practice Address - Country:US
Practice Address - Phone:337-354-1401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200773363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical