NPIMap

Organization Active NPI

Dale Tate FNP LLC

  • Family Nurse Practitioner
  • Kentwood, LA
National Provider Identifier
1124360144
Registry record updated Mar 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN102323/AP06135 Issued in LA
Legal business name
DALE TATE FNP LLC
Practice address
75136 N River Rd
Kentwood, LA 70444-3800
Phone
(985) 229-4114
NPI assigned
Mar 18, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Bryan Dale Tate Jr., FNP
Title
Owner
Phone
(985) 229-4114

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X RN102323/AP06135 LA Primary

Addresses

Primary practice location

75136 N River Rd
Kentwood, LA 70444-3800

Mailing address

75136 N River Rd
Kentwood, LA 70444-3800
Phone (985) 229-4114

Other identifiers 1

IdentifierTypeStateIssuer
2115014MedicaidLA

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1363564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363564800000",
    "number": "1124360144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75136 N RIVER RD",
            "city": "KENTWOOD",
            "state": "LA",
            "postal_code": "704443800",
            "telephone_number": "985-229-4114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75136 N RIVER RD",
            "city": "KENTWOOD",
            "state": "LA",
            "postal_code": "704443800",
            "telephone_number": "985-229-4114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DALE TATE FNP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-18",
        "last_updated": "2013-03-18",
        "status": "A",
        "authorized_official_last_name": "TATE",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "985-229-4114",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "RN102323/AP06135",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2115014",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kentwood, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.