Athena Lee Castilleja Ezernack, IDMT

Primary specialty

Independent Duty Medical TechniciansTaxonomy code 1710I1003X

Practice address

407 Barksdale Blvd E
Barksdale Afb, LA 71110-2125

Phone

(318) 456-6165

NPI assigned

Dec 23, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1261526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1261526400000",
    "number": "1790014660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 BARKSDALE BLVD E",
            "city": "BARKSDALE AFB",
            "state": "LA",
            "postal_code": "711102125",
            "telephone_number": "318-456-6165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 BARKSDALE BLVD E",
            "city": "BARKSDALE AFB",
            "state": "LA",
            "postal_code": "711102125",
            "telephone_number": "318-456-6165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CASTILLEJA EZERNACK",
        "first_name": "ATHENA",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "IDMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-12-23",
        "last_updated": "2009-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1003X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Medical Technicians",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ella W Bradford, LCSW
• Charlotte Emma Buckley, PHARMD
• Lisset Jerenny Bushee, PHARM D
• Sherry D. Carter, PA
• Brandi Casey, RN
• Larin Timothy Clark, IDMT, LPN
• Robert Corey
• Christy Suk Cruz-Peeler, LCSW, BCD, DSW
• Michael Sean Daugherty, PA
• Luke Jonathan Davidiuk, PSY.D.

• Independent Duty Medical Technicians in Barksdale Afb, LA
• Providers in Barksdale Afb, LA by specialty
• Independent Duty Medical Technicians in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 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.