Provider Demographics
NPI:1720164379
Name:WEBB, PATRICIA (NP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:WEBB
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 S SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:VIVIAN
Mailing Address - State:LA
Mailing Address - Zip Code:71082-3200
Mailing Address - Country:US
Mailing Address - Phone:318-375-4003
Mailing Address - Fax:
Practice Address - Street 1:112 FOREST STREET
Practice Address - Street 2:
Practice Address - City:PLAIN DEALING
Practice Address - State:LA
Practice Address - Zip Code:71064
Practice Address - Country:US
Practice Address - Phone:318-326-7272
Practice Address - Fax:318-326-7282
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2005007456363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1444286Medicaid
LA2302639Medicaid
LA1370215Medicaid
LA1444286Medicaid