Provider Demographics
NPI:1982604187
Name:ROUGEAU, CORINNE KAUFFELD (NP)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:KAUFFELD
Last Name:ROUGEAU
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 1:5131 ODONOVAN DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4791
Mailing Address - Country:US
Mailing Address - Phone:225-374-0220
Mailing Address - Fax:225-374-0221
Practice Address - Street 1:5131 ODONOVAN DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4791
Practice Address - Country:US
Practice Address - Phone:225-374-0220
Practice Address - Fax:225-374-0221
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP02285363LF0000X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1551384Medicaid
LA5X835Medicare PIN
LA5X835C822Medicare PIN
LA1551384Medicaid
LA3C839C822Medicare PIN
LAS80108Medicare UPIN
LA5X835DX80Medicare PIN