Provider Demographics
NPI:1144715244
Name:DAIGLE, KATHERINE WEIMER (PA-C)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:WEIMER
Last Name:DAIGLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:762 HIGHWAY 308
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-5758
Mailing Address - Country:US
Mailing Address - Phone:985-859-0288
Mailing Address - Fax:
Practice Address - Street 1:1001 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4629
Practice Address - Country:US
Practice Address - Phone:985-868-1540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-30
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA308919363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant