DNP-Outpatient

Primary specialty

Neurodevelopmental Disabilities PhysicianTaxonomy code 2084P0005X

Legal business name

DNP-OUTPATIENT

Practice address

23515 Hwy 190
Mandeville, LA 70448

Phone

(985) 626-6300

Fax

(985) 626-6557

NPI assigned

Jun 17, 2009

Organization subpart

Yes

Parent organization

SOUTHEAST LOUISIANA STATE HOSPITALAs reported in NPPES

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

Authorized official

Name

Patricia Gonzales

Title

C.E.O.

Phone

(985) 626-6300

Specialties & licenses 1

Addresses

Tax ID family

Southeast Louisana State Hospital3 organizations share this tax ID, including this one

Part of

Southeast Louisana State Hospital

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Challenges-Day Program

  • Child & Adolescent Psychiatry Physician
  • Mandeville, LA
  • NPI 1770710741
  NPD tax ID
• Southeast Louisiana State Hospital

  • Psychiatry Physician
  • Mandeville, LA
  • NPI 1518129907
  NPD tax ID

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Southeast Louisiana State Hospital

  • Psychiatry Physician
  • Mandeville, LA
  • NPI 1518129907
  NPPES parent name

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

{
    "created_epoch": "1245196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245196800000",
    "number": "1235366204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3850",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704703850",
            "telephone_number": "985-626-6300",
            "fax_number": "985-626-6557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23515 HWY 190",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "70448",
            "telephone_number": "985-626-6300",
            "fax_number": "985-626-6557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DNP-OUTPATIENT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHEAST LOUISIANA STATE HOSPITAL",
        "enumeration_date": "2009-06-17",
        "last_updated": "2009-06-17",
        "status": "A",
        "authorized_official_last_name": "GONZALES",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "985-626-6300"
    },
    "taxonomies": [
        {
            "code": "2084P0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurodevelopmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jere Michael Disney, MD
• Randi Ditta, LPC
• Pamella B Divinity
• DMS Group, LLC
• Dna Chiropractic LLC
• Kathryn Allison Dobbins
• Nancy Dominick-Gravel, D.C.,
• Ryshon Donaldson
• Kellie S Doolittle, LOTR
• Kirstie Alexa Dotson, CCC-SLP

• Neurodevelopmental Disabilities Physician in Mandeville, LA
• Providers in Mandeville, LA by specialty
• Neurodevelopmental Disabilities Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2009; 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.