Provider Demographics
NPI:1982796991
Name:BOURGEOIS, NICOLE ORGERON (PA-C)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:ORGERON
Last Name:BOURGEOIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:LYNN
Other - Last Name:ORGERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:525 SAINT MARY ST
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-2627
Mailing Address - Country:US
Mailing Address - Phone:985-446-6284
Mailing Address - Fax:985-447-1754
Practice Address - Street 1:525 SAINT MARY ST
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301
Practice Address - Country:US
Practice Address - Phone:985-446-6284
Practice Address - Fax:985-447-1754
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LATP507363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00395268OtherRAILROAD MEDICARE
LAP00395268OtherRAILROAD MEDICARE