Provider Demographics
NPI:1063624716
Name:ST. PIERRE, MARY J (NP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:ST. PIERRE
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:FNP
Mailing Address - Street 2:2 MDG/SGHC; AEROSPACE MEDICINE; SUITE 100
Mailing Address - City:BARKSDALE AFB
Mailing Address - State:LA
Mailing Address - Zip Code:71110-2425
Mailing Address - Country:US
Mailing Address - Phone:318-456-6131
Mailing Address - Fax:318-456-6246
Practice Address - Street 1:243 CURTISS RD
Practice Address - Street 2:2 MDG/SGHC; AEROSPACE MEDICINE; SUITE 100
Practice Address - City:BARKSDALE AFB
Practice Address - State:LA
Practice Address - Zip Code:71110-2425
Practice Address - Country:US
Practice Address - Phone:318-456-6131
Practice Address - Fax:318-456-6246
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAAP04153363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1143723Medicaid
LA4C843Medicare ID - Type Unspecified
LA1143723Medicaid