Lisa Rene Deshotel, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA.A 10431RX Issued in LA

Practice address

1602 W Pinhook Rd
Suite 100
Lafayette, LA 70508-3735

Phone

(337) 234-9925

Fax

(337) 237-5211

NPI assigned

Mar 11, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ahs Walk in Clinic Inc

  dba SouthStar Urgent Care

  • Urgent Care Clinic/Center
  • Youngsville, LA
  • NPI 1639234495
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1750413225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 ISAIAH DR",
            "address_2": "LAFAYETTE, LA",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705085392",
            "telephone_number": "337-261-5232",
            "fax_number": "337-237-5211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1602 W PINHOOK RD",
            "address_2": "SUITE 100",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083735",
            "telephone_number": "337-234-9925",
            "fax_number": "337-237-5211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESHOTEL",
        "first_name": "LISA",
        "middle_name": "RENE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "LA",
            "license": "PA.A 10431RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter Brian Derouen
• Emma D. Derousselle, SLP
• Gabriel L Dersam, MD
• Anu Gupta Desai, M.D.
• Karen M Deshotel, MSN,FNPC
• Leigh Victoria Deshotels, MD
• Natalie Deshotels, PA
• Linda Desormeaux, CCC-SLP
• Mallory Claire Desormeaux, MA, BCBA
• Shayla R. Despanie

• Medical Physician Assistant in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Medical Physician Assistant in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.