1689124687 NPI number — DR. ALYSE BARKER BLANCHARD PH.D.

Table of content: DR. ALYSE BARKER BLANCHARD PH.D. (NPI 1689124687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689124687 NPI number — DR. ALYSE BARKER BLANCHARD PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLANCHARD
Provider First Name:
ALYSE
Provider Middle Name:
BARKER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARKER
Provider Other First Name:
ALYSE
Provider Other Middle Name:
ANN
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:
1689124687
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
142 RUE MARGUERITE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
THIBODAUX
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70301-6746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-625-0023
Provider Business Mailing Address Fax Number:
985-625-0022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
142 RUE MARGUERITE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
THIBODAUX
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70301-6708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-625-0023
Provider Business Practice Location Address Fax Number:
985-625-0022
Provider Enumeration Date:
10/13/2016

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: 103TC0700X , with the licence number:  1343 , 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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