Provider Demographics
NPI:1811611387
Name:SAGRERA, PAYTON SIMMONS (PA-C)
Entity type:Individual
Prefix:
First Name:PAYTON
Middle Name:SIMMONS
Last Name:SAGRERA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PAYTON
Other - Middle Name:
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-374-1528
Mailing Address - Fax:225-374-1611
Practice Address - Street 1:8300 CONSTANTIN BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3489
Practice Address - Country:US
Practice Address - Phone:225-374-1528
Practice Address - Fax:225-374-1611
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA333908363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant