Provider Demographics
NPI:1821421538
Name:PELAFIGUE, ABIGAIL THERESA
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:THERESA
Last Name:PELAFIGUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:225-765-5727
Mailing Address - Fax:225-765-4278
Practice Address - Street 1:4809 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:SUITE 430
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-8800
Practice Address - Country:US
Practice Address - Phone:337-470-4978
Practice Address - Fax:337-470-4237
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07411363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1338109Medicaid
LA332946YJQDMedicare PIN