Organization Name: | DALE TATE FNP LLC |
NPI Number: | 1124360144 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BRYAN DALE TATE (OWNER) |
Mailing Address: | 75136 N River Rd Kentwood |
State: | LA US |
Postal Code: | 704443800 |
Phone Number: | 9852294114 |
Fax Number: | |
NPI Enumeration Date: | 03/18/2013 |
NPI Last Update Date: | 03/18/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | RN102323/AP06135 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |