Provider Demographics
NPI:1013635937
Name:LOTTINGER, PHILIP ANDREW JR (PMHNP)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:ANDREW
Last Name:LOTTINGER
Suffix:JR
Gender:M
Credentials:PMHNP
Other - Prefix:MR
Other - First Name:PHILIP
Other - Middle Name:ANDREW
Other - Last Name:LOTTINGER
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP
Mailing Address - Street 1:235 CIVIC CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-5937
Mailing Address - Country:US
Mailing Address - Phone:985-851-0162
Mailing Address - Fax:
Practice Address - Street 1:235 CIVIC CENTER BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-5937
Practice Address - Country:US
Practice Address - Phone:985-851-0162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA227136363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health