Active NPI
Louise L Tichenor, PA
- Physician Assistant
- Malone, NY
National Provider Identifier
1053480244
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 4851577
- Practice address
- 336 Elm St
Malone, NY 12953-1514 - Phone
- (518) 483-0022
- Fax
- (518) 483-6179
- NPI assigned
- Nov 6, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 4851577 | NY | Primary |
Addresses
Primary practice location
336 Elm St
Malone, NY 12953-1514
Mailing address
336 Elm St
Malone, NY 12953-1514
Phone (518) 483-0022
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01916090 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4851577 | NY | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alice Hyde Medical Center | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Skilled Nursing Facility
- Malone, NY
- NPI 1356441349
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1053480244",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "336 ELM ST",
"city": "MALONE",
"state": "NY",
"postal_code": "129531514",
"telephone_number": "518-483-0022",
"fax_number": "518-483-6179"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "336 ELM ST",
"city": "MALONE",
"state": "NY",
"postal_code": "129531514",
"telephone_number": "518-483-0022",
"fax_number": "518-483-6179"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TICHENOR",
"first_name": "LOUISE",
"middle_name": "L",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "4851577",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01916090",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Malone, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.