Provider Demographics
NPI:1265985915
Name:TRICHE, GAVIN (PA-C)
Entity type:Individual
Prefix:MR
First Name:GAVIN
Middle Name:
Last Name:TRICHE
Suffix:
Gender:M
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 1:128 NEUROSCIENCE COURT
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:LA
Mailing Address - Zip Code:70359
Mailing Address - Country:US
Mailing Address - Phone:985-917-3007
Mailing Address - Fax:
Practice Address - Street 1:128 NEUROSCIENCE COURT
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:LA
Practice Address - Zip Code:70359
Practice Address - Country:US
Practice Address - Phone:985-917-3007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA302680363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant