Provider Demographics
NPI:1184069346
Name:PREVOST, ALLISON RENEE DUPUIS (M D)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:RENEE DUPUIS
Last Name:PREVOST
Suffix:
Gender:F
Credentials:M D
Other - Prefix:MS
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:DUPUIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-526-0018
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:2647 S SAINT ELIZABETH BLVD STE 320
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-5017
Practice Address - Country:US
Practice Address - Phone:225-647-8511
Practice Address - Fax:225-647-5093
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA302658208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program