Provider Demographics
NPI:1457609828
Name:DEBAUTTE, ALICIA CALLAIS (NP-C)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:CALLAIS
Last Name:DEBAUTTE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:MARIE
Other - Last Name:CALLAIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4015
Mailing Address - Fax:504-842-0098
Practice Address - Street 1:1514 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2429
Practice Address - Country:US
Practice Address - Phone:504-842-4015
Practice Address - Fax:504-842-0098
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06870363LF0000X
LARN107124363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily