Individual
BRYAN D. TATE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
919 AVENUE G, KENTWOOD, LA 70444
(985) 229-0202
(985) 229-2859
Mailing address
75136 N RIVER RD, KENTWOOD, LA 70444-3800
(985) 229-0202
(985) 229-2859
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP06135
LA
363L00000X
Nurse Practitioner
RN102323 AP06135
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2115014
—
LA
Enumeration date
06/15/2010
Last updated
02/19/2016
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