Individual
TIMOTHY J PELLEGRIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
1014 W TUNNEL BLVD, HOUMA, LA 70360-4050
(985) 851-1717
(985) 868-3839
Mailing address
1115 WEBER ST, FRANKLIN, LA 70538-4124
(337) 828-2550
(337) 355-2335
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APO4222
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1152919
—
LA
01
—
4C669
MEDICARE NUMBER
LA
01
—
568555
MEDICARE
LA
Enumeration date
06/10/2006
Last updated
06/17/2022
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