Basic Information
| Provider Information | |||||||||
| NPI: | 1518997253 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEBERT | ||||||||
| FirstName: | BYRON | ||||||||
| MiddleName: | RAY | ||||||||
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| Credential: | C.R.N.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 977 | ||||||||
| Address2: | |||||||||
| City: | ABBEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705110977 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3378927634 | ||||||||
| FaxNumber: | 3378927634 | ||||||||
| Practice Location | |||||||||
| Address1: | 204 N MAGDALEN SQ | ||||||||
| Address2: | |||||||||
| City: | ABBEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705104645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3378934531 | ||||||||
| FaxNumber: | 3378930825 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 367500000X | RN045176 AP02303 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 1390631 | 05 | LA | MEDICAID |