Healthcare Provider Details

I. General information

NPI: 1700088788
Provider Name (Legal Business Name): PAMELA B. EGAN MN, FNP-C, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2007
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 W 21ST AVE.
COVINGTON LA
70433-7407
US

IV. Provider business mailing address

190 EAGLE RD
COVINGTON LA
70435-9426
US

V. Phone/Fax

Practice location:
  • Phone: 985-892-3031
  • Fax: 985-892-9504
Mailing address:
  • Phone: 985-898-0770
  • Fax: 985-898-0770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number39110 2195
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number39110 2195
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number39110 2195
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: