Organization
DALE TATE FNP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRYAN DALE TATE JR. FNP (OWNER)
(985) 229-4114
Entity
Organization
Contact information
Practice address
75136 N RIVER RD, KENTWOOD, LA 70444-3800
(985) 229-4114
Mailing address
75136 N RIVER RD, KENTWOOD, LA 70444-3800
(985) 229-4114
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN102323/AP06135
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2115014
—
LA
Enumeration date
03/18/2013
Last updated
03/18/2013
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