1780068106 NPI number — KEYLA PARKER

Table of content: KEYLA PARKER (NPI 1780068106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780068106 NPI number — KEYLA PARKER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKER
Provider First Name:
KEYLA
Provider Middle Name:
Provider Name Prefix Text:
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:
1780068106
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12224 KINGSTON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70807-2072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-978-8601
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
58026 FORT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAQUEMINE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70764-3222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-685-1163
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2015

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: 261QM0801X , 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: 600723334 . This is a "SEASIDE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com