Provider Demographics
NPI:1194756635
Name:PITRE, FREDERICK R (CRNA)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:R
Last Name:PITRE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:RAY
Other - Middle Name:
Other - Last Name:PITRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:501 KEYSER AVE
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457
Mailing Address - Country:US
Mailing Address - Phone:318-214-4283
Mailing Address - Fax:847-615-2858
Practice Address - Street 1:501 KEYSER AVE
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-6018
Practice Address - Country:US
Practice Address - Phone:318-214-4283
Practice Address - Fax:847-615-2858
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP102044367500000X
LARN044466163W00000X
LAAPO1838367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1964662Medicaid
LA1964662Medicaid