Provider Demographics
NPI:1366157737
Name:DEGEYTER, BETH ALEXANDRA (FNP-C)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ALEXANDRA
Last Name:DEGEYTER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WESTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6241
Mailing Address - Country:US
Mailing Address - Phone:337-322-2582
Mailing Address - Fax:
Practice Address - Street 1:605 SILVERSTONE RD STE 100
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6899
Practice Address - Country:US
Practice Address - Phone:337-266-9985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA229230363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily