Provider Demographics
NPI:1619226727
Name:PILCHER, MICAH BOYETT (CPNP)
Entity type:Individual
Prefix:MRS
First Name:MICAH
Middle Name:BOYETT
Last Name:PILCHER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2787 BRADSHAW RD
Mailing Address - Street 2:
Mailing Address - City:GRAND CANE
Mailing Address - State:LA
Mailing Address - Zip Code:71032-6076
Mailing Address - Country:US
Mailing Address - Phone:318-469-3083
Mailing Address - Fax:
Practice Address - Street 1:2829 YOUREE DR STE 1
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-3640
Practice Address - Country:US
Practice Address - Phone:318-402-0131
Practice Address - Fax:318-409-0171
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2024-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07029363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAP07029OtherAPRN
FLTPAN2520OtherAPRN
TX1155694OtherAPRN
LA2314122Medicaid