Basic Information
| Provider Information | |||||||||
| NPI: | 1619977824 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POURCIAU | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5959 S SHERWOOD FOREST BLVD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708166038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2255260006 | ||||||||
| FaxNumber: | 2257659291 | ||||||||
| Practice Location | |||||||||
| Address1: | 6516 E MYRTLE AVE | ||||||||
| Address2: | |||||||||
| City: | BAKER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707144348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257747320 | ||||||||
| FaxNumber: | 2257745432 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2005 | ||||||||
| LastUpdateDate: | 04/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 374772031 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1543713 | 05 | LA | MEDICAID |