1962633925 NPI number — MRS. ERICKA KELLER PATE NP

Table of content: MRS. ERICKA KELLER PATE NP (NPI 1962633925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962633925 NPI number — MRS. ERICKA KELLER PATE NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATE
Provider First Name:
ERICKA
Provider Middle Name:
KELLER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962633925
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P O BOX 50
Provider Second Line Business Mailing Address:
355 HIGHWAY 3142
Provider Business Mailing Address City Name:
HAHNVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-783-5668
Provider Business Mailing Address Fax Number:
985-783-4179

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
355 HIGHWAY 3142
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAHNVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-783-5668
Provider Business Practice Location Address Fax Number:
985-783-4179
Provider Enumeration Date:
08/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  AP05887 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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