Provider Demographics
NPI:1316294671
Name:PREJEAN, ANNA KATHARINE (NP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:KATHARINE
Last Name:PREJEAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:KATHARINE
Other - Last Name:MELANSON PREJEAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4811 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:STE 305
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7266
Mailing Address - Country:US
Mailing Address - Phone:337-470-3043
Mailing Address - Fax:337-470-2019
Practice Address - Street 1:501 W SAINT MARY BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-4600
Practice Address - Country:US
Practice Address - Phone:337-470-4801
Practice Address - Fax:337-470-4840
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06815363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2307908Medicaid
LARN062211OtherLA RN
LAAP06815OtherLA APRN
LAA0312069OtherCERTIFICATION NUMBER
LARN062211OtherLA RN