Provider Demographics
NPI:1962437970
Name:PREVOT, TROY JAMES (PA)
Entity type:Individual
Prefix:MR
First Name:TROY
Middle Name:JAMES
Last Name:PREVOT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 SHADY LAKE PL W
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-4332
Mailing Address - Country:US
Mailing Address - Phone:225-274-6760
Mailing Address - Fax:225-216-4299
Practice Address - Street 1:2351 ENERGY DR
Practice Address - Street 2:SUITE 2000
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-2618
Practice Address - Country:US
Practice Address - Phone:225-274-6760
Practice Address - Fax:225-216-4299
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.A10161.RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1349976Medicaid
LA5C822P744Medicare PIN
LA1349976Medicaid