Individual
PATRICE JENNE TYSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7777 HENNESSY BLVD, SUITE 409, BATON ROUGE, LA 70808-4300
(225) 765-6834
(225) 765-2054
Mailing address
7777 HENNESSY BLVD, SUITE 409, BATON ROUGE, LA 70808-4300
(225) 765-6834
(225) 765-2054
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
35090026
OH
208000000X
Pediatrics Physician
MD.025783
LA
2080P0206X
Pediatric Gastroenterology Physician
Primary
MD.025783
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000225140
UNISON
OH
01
—
000000530761
ANTHEM
OH
05
—
03659802
—
MS
01
—
1021891110001
PA MEDICAID
PA
05
—
1044121
—
LA
05
—
2745551
—
OH
01
—
415048
WELLCARE
OH
01
—
749095
BUCKEYE
OH
01
—
962065
AETNA
OH
Enumeration date
07/10/2007
Last updated
10/25/2013
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