Provider Demographics
NPI:1700088788
Name:EGAN, PAMELA B (MN, FNP-C, CDE)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:B
Last Name:EGAN
Suffix:
Gender:F
Credentials:MN, FNP-C, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70435-9426
Mailing Address - Country:US
Mailing Address - Phone:985-898-0770
Mailing Address - Fax:985-898-0770
Practice Address - Street 1:1116 W 21ST AVE.
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7407
Practice Address - Country:US
Practice Address - Phone:985-892-3031
Practice Address - Fax:985-892-9504
Is Sole Proprietor?:No
Enumeration Date:2007-06-02
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA39110 2195363LA2200X, 363LF0000X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1547255Medicaid
LA1547255Medicaid
LA5X785Medicare ID - Type Unspecified