Healthcare Provider Details

I. General information

NPI: 1316342538
Provider Name (Legal Business Name): KENNETH J PITCHER N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15790 PAUL VEGA MD DR
HAMMOND LA
70403-1434
US

IV. Provider business mailing address

217 CHEROKEE ROSE LN
COVINGTON LA
70433-7201
US

V. Phone/Fax

Practice location:
  • Phone: 985-230-1359
  • Fax: 985-230-6480
Mailing address:
  • Phone: 985-893-0911
  • Fax: 985-875-7565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP08065
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP08065
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: