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General NPI Number Information
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NPI Number | 1245036540
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Entity Type | Organization
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Legal Business Name | VIDRINE PSYCHIATRY LLC
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 689 E AIRPORT AVE STE 1
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City | BATON ROUGE
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State | LA
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Zip | 70806-6557
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Country | US
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Telephone | 225-268-1412
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Fax |
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Provider Business Mailing Address
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Address Line | 689 E AIRPORT AVE STE 1
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City | BATON ROUGE
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State | LA
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Zip | 70806-6557
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ASHTON C VIDRINE
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Credential | APRN, PMHNP-BC, LMSW
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Telephone | 225-268-1412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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