Provider Demographics
NPI:1437160231
Name:PITRE, SIMONE ADEL (C-NP)
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:ADEL
Last Name:PITRE
Suffix:
Gender:F
Credentials:C-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CURRAN LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-7222
Mailing Address - Country:US
Mailing Address - Phone:337-706-7700
Mailing Address - Fax:337-706-7710
Practice Address - Street 1:1305 N STATE ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-2825
Practice Address - Country:US
Practice Address - Phone:337-422-6240
Practice Address - Fax:337-422-6241
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME67000-3451363L00000X
LAAP03451363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5X9147191OtherMEDICARE
LA1558800Medicaid
LAS84493Medicare UPIN