Basic Information
| Provider Information | |||||||||
| NPI: | 1023533502 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CREGER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | APRN, PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 224 BAYOU GENTILLY LN | ||||||||
| Address2: | |||||||||
| City: | KENNER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700656628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044530380 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 716 VILLAGE RD STE A | ||||||||
| Address2: | |||||||||
| City: | KENNER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700652751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044648895 | ||||||||
| FaxNumber: | 5044648896 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2017 | ||||||||
| LastUpdateDate: | 08/07/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | AP09263 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.