Provider Demographics
NPI:1386118032
Name:PELLICHINO, NAOMI HESS (PA-C)
Entity type:Individual
Prefix:MRS
First Name:NAOMI
Middle Name:HESS
Last Name:PELLICHINO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 OCHSNER BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-8246
Mailing Address - Country:US
Mailing Address - Phone:985-892-2950
Mailing Address - Fax:
Practice Address - Street 1:1431 OCHSNER BLVD STE B
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8246
Practice Address - Country:US
Practice Address - Phone:985-892-2950
Practice Address - Fax:985-892-2980
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA311625363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant