Provider Demographics
NPI:1528720778
Name:BRASSEAUX, PEPPER MARIE (RVT-VT; RDMS-AB)
Entity type:Individual
Prefix:
First Name:PEPPER
Middle Name:MARIE
Last Name:BRASSEAUX
Suffix:
Gender:F
Credentials:RVT-VT; RDMS-AB
Other - Prefix:
Other - First Name:PEPPER
Other - Middle Name:MARIE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RVT-VT
Mailing Address - Street 1:218 CALDWELL SUGAR RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-6698
Mailing Address - Country:US
Mailing Address - Phone:337-288-0736
Mailing Address - Fax:
Practice Address - Street 1:218 CALDWELL SUGAR RD
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-6698
Practice Address - Country:US
Practice Address - Phone:337-288-0736
Practice Address - Fax:337-892-1238
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA98098156F00000X, 246X00000X, 246XC2903X, 246XS1301X, 2471S1302X, 405300000X, 2471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
No156F00000XEye and Vision Services ProvidersTechnician/Technologist
No246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist Cardiovascular
No246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular Specialist
No246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No405300000XOther Service ProvidersPrevention Professional