Healthcare Provider Details

I. General information

NPI: 1568624757
Provider Name (Legal Business Name): MS. PATEICIA ANN MCCORKLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2008
Last Update Date: 06/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7262 POINSETTIA DR
BATON ROUGE LA
70812-1861
US

IV. Provider business mailing address

7185 SCOBELL DR SUITE C
BATON ROUGE LA
70806-1502
US

V. Phone/Fax

Practice location:
  • Phone: 225-288-6931
  • Fax: 225-935-2209
Mailing address:
  • Phone: 225-935-2208
  • Fax: 225-935-2209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberSIL20075
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: