Healthcare Provider Details

I. General information

NPI: 1326925843
Provider Name (Legal Business Name): BREIGH PEYTAVIN LOUPE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 09/06/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15389 AIRLINE HWY
BATON ROUGE LA
70817-7312
US

IV. Provider business mailing address

40456 LA 3125
PAULINA LA
70763-2281
US

V. Phone/Fax

Practice location:
  • Phone: 225-753-7233
  • Fax:
Mailing address:
  • Phone: 225-202-8031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number348183
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: