Provider Demographics
NPI:1366102188
Name:HEBERT, RICHARD III (PA)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:HEBERT
Suffix:III
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16469 SUMMERLIN DR
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-4827
Mailing Address - Country:US
Mailing Address - Phone:985-789-9270
Mailing Address - Fax:
Practice Address - Street 1:7777 HENNESSY BLVD STE 1008
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4368
Practice Address - Country:US
Practice Address - Phone:225-766-0416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA330027363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant