Provider Demographics
NPI:1316342538
Name:PITCHER, KENNETH J (NP)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:PITCHER
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:217 CHEROKEE ROSE LN
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7201
Mailing Address - Country:US
Mailing Address - Phone:985-893-0911
Mailing Address - Fax:985-875-7565
Practice Address - Street 1:15790 PAUL VEGA MD DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1434
Practice Address - Country:US
Practice Address - Phone:985-230-1359
Practice Address - Fax:985-230-6480
Is Sole Proprietor?:No
Enumeration Date:2014-10-30
Last Update Date:2020-09-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAAP08065363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2379003Medicaid