=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417262361
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CASEY DUFRENE PECH FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2010
-----------------------------------------------------
Last Update Date | 01/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 406 N ACADIA RD
-----------------------------------------------------
City | THIBODAUX
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70301-4856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-446-2890
-----------------------------------------------------
Fax | 985-446-2189
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1216 N VICTOR II BLVD STE 100
-----------------------------------------------------
City | MORGAN CITY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70380-1392
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-702-2229
-----------------------------------------------------
Fax | 985-384-0329
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LX0001X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
-----------------------------------------------------
License Number | RN084493 AP06207
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------