Provider Demographics
NPI:1073626719
Name:POCHE, KEITH MICHAEL (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:MICHAEL
Last Name:POCHE
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Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:403 HOLIDAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301
Mailing Address - Country:US
Mailing Address - Phone:985-851-0118
Mailing Address - Fax:985-851-0116
Practice Address - Street 1:1750 MARTIN LUTHER KING BLVD.,
Practice Address - Street 2:SUITE 107
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360
Practice Address - Country:US
Practice Address - Phone:985-851-0118
Practice Address - Fax:985-851-0116
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAA10444.RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical