1417597022 NPI number — MRS. PAMELA COOLIE GIVENS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417597022 NPI number — MRS. PAMELA COOLIE GIVENS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIVENS
Provider First Name:
PAMELA
Provider Middle Name:
COOLIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
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:
1417597022
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4201 N 1-10 SERVICE RD W. METAIRIE
Provider Second Line Business Mailing Address:
NEW ORLEANS,LOUISIANA, 70006
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-475-5303
Provider Business Mailing Address Fax Number:
888-880-9270

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4747 EARHART BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70125-1743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-482-2600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/11/2020

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: 106S00000X , 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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