Provider Demographics
NPI:1962693374
Name:HEBERT, LORI FERREBEE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:FERREBEE
Last Name:HEBERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:LORI
Other - Middle Name:BETH
Other - Last Name:FERREBEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:8166 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-3404
Mailing Address - Country:US
Mailing Address - Phone:985-873-4247
Mailing Address - Fax:985-873-3772
Practice Address - Street 1:8166 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-3404
Practice Address - Country:US
Practice Address - Phone:800-456-9121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LATEMP363A00000X
LAPA.200.152.RX364SE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SE0003XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistEmergency
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA09251984OtherDOB