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General NPI Number Information
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NPI Number | 1386163335
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Entity Type | Individual
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Provider Name | BETHANY ARDOIN VERRET PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/11/2017
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Last Update Date | 10/19/2023
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Provider Practice Location Address
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Address Line | 1530 E MCNEESE ST STE 1
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City | LAKE CHARLES
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State | LA
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Zip | 70607-4784
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Country | US
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Telephone | 337-564-5322
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Fax |
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Provider Business Mailing Address
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Address Line | 1917 PLANTATION DR
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City | LAKE CHARLES
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State | LA
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Zip | 70605-5265
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Country | US
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Telephone | 337-526-8547
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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 | PA12054
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 306455
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License Number State | LA
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