Provider Demographics
NPI:1184617623
Name:MIRE, JOYCE CATHERINE (ANP)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:CATHERINE
Last Name:MIRE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8585 PICARDY AVE STE 114
Mailing Address - Street 2:HMG- BATON ROUGE GENERAL
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3679
Mailing Address - Country:US
Mailing Address - Phone:225-387-7700
Mailing Address - Fax:225-372-3717
Practice Address - Street 1:8585 PICARDY AVE STE 114
Practice Address - Street 2:HMG- BATON ROUGE GENERAL
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3679
Practice Address - Country:US
Practice Address - Phone:225-387-7700
Practice Address - Fax:225-372-3717
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04257363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00408731OtherRAILROAD MEDICARE
LA1177199Medicaid
4C892DX80OtherMEDICARE
LAP00408731OtherRAILROAD MEDICARE
4C892DX80OtherMEDICARE