Provider Demographics
NPI:1386163335
Name:VERRET, BETHANY ARDOIN (PA-C)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:ARDOIN
Last Name:VERRET
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 1:1917 PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5265
Mailing Address - Country:US
Mailing Address - Phone:337-526-8547
Mailing Address - Fax:
Practice Address - Street 1:1530 E MCNEESE ST STE 1
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-4784
Practice Address - Country:US
Practice Address - Phone:337-564-5322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12054363A00000X
LA306455363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant