Organization
DALE TATE, FNP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRYAN DALE TATE JR. FNP-C (SOLE MEMBER)
(985) 229-4114
Entity
Organization
Contact information
Practice address
2004 J MARVIN MAGEE DR, FRANKLINTON, LA 70438-9799
(985) 839-3555
(985) 839-6320
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
AP06135
LA
Other
Enumeration date
09/06/2011
Last updated
09/06/2011
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