1134452394 NPI number — ANGELA L ROY PA

Table of content: ANGELA L ROY PA (NPI 1134452394)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134452394 NPI number — ANGELA L ROY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROY
Provider First Name:
ANGELA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANGELLE
Provider Other First Name:
ANGELA
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134452394
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36139 WESTIN RIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GEISMAR
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70734-3437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-237-1810
Provider Business Mailing Address Fax Number:
225-763-4117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8585 PICARDY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70809-3748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-237-1810
Provider Business Practice Location Address Fax Number:
225-763-4117
Provider Enumeration Date:
09/04/2009

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: 363A00000X , with the licence number:  PA200271 , 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)

  • Identifier: 03053256 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1894125 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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