1114222981 NPI number — AMY KYGER MARKERSON PA-C

Table of content: AMY KYGER MARKERSON PA-C (NPI 1114222981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114222981 NPI number — AMY KYGER MARKERSON PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARKERSON
Provider First Name:
AMY
Provider Middle Name:
KYGER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KYGER
Provider Other First Name:
AMY
Provider Other Middle Name:
E.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114222981
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1522 CITY PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GONZALES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70737-4538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-234-0102
Provider Business Mailing Address Fax Number:
225-927-0547

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3333 DRUSILLA LN
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70809-2418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-924-4460
Provider Business Practice Location Address Fax Number:
225-927-0547
Provider Enumeration Date:
01/25/2011

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: 363A00000X , with the licence number:  PA.200549 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: 2011001804 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2322443 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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