Healthcare Provider Details

I. General information

NPI: 1659557940
Provider Name (Legal Business Name): EDIE B POURCIAU ANP-BC,PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EDIE B BOUDREAUX ANP-BC,PMHNP-BC

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 09/29/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PATTERSON ST
LAFAYETTE LA
70501-1849
US

IV. Provider business mailing address

PO BOX 9227
NEW IBERIA LA
70562-9227
US

V. Phone/Fax

Practice location:
  • Phone: 337-769-9451
  • Fax: 337-769-9460
Mailing address:
  • Phone: 337-608-9922
  • Fax: 337-608-9933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP05466
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP05466
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN102783
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: