Healthcare Provider Details

I. General information

NPI: 1487402855
Provider Name (Legal Business Name): ASHTON C VIDRINE APRN, PMHNP-BC, LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

689 E AIRPORT AVE STE 3
BATON ROUGE LA
70806-6557
US

IV. Provider business mailing address

689 E AIRPORT AVE STE 3
BATON ROUGE LA
70806-6557
US

V. Phone/Fax

Practice location:
  • Phone: 225-268-1412
  • Fax:
Mailing address:
  • Phone: 225-268-1412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202801
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12373
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: