Healthcare Provider Details

I. General information

NPI: 1164980330
Provider Name (Legal Business Name): TERRI KAYE ALLAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9420 LINDALE AVE STE B
BATON ROUGE LA
70815-4161
US

IV. Provider business mailing address

9420 LINDALE AVE STE B
BATON ROUGE LA
70815-4161
US

V. Phone/Fax

Practice location:
  • Phone: 225-442-3540
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number138216
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: