Healthcare Provider Details

I. General information

NPI: 1710824073
Provider Name (Legal Business Name): VIRGINIA LEE MASON PMHNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 N FLORIDA ST
COVINGTON LA
70433-1544
US

IV. Provider business mailing address

1505 N FLORIDA ST
COVINGTON LA
70433-1544
US

V. Phone/Fax

Practice location:
  • Phone: 985-900-1626
  • Fax:
Mailing address:
  • Phone: 985-900-1626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209546
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: