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General NPI Number Information
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NPI Number | 1326925843
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Entity Type | Individual
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Provider Name | BREIGH NICOLE PEYTAVIN PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/18/2025
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 602 N ACADIA RD
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City | THIBODAUX
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State | LA
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Zip | 70301-4823
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Country | US
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Telephone | 985-447-5500
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Fax |
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Provider Business Mailing Address
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Address Line | 1885 FELICITY CT
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City | LUTCHER
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State | LA
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Zip | 70071-5616
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Country | US
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Telephone | 225-202-8031
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 348183
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License Number State | LA
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