Healthcare Provider Details

I. General information

NPI: 1174999734
Provider Name (Legal Business Name): ALISON KUSKE VERLANDER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISON A. KUSKE

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 SUMMA AVE
BATON ROUGE LA
70809-3726
US

IV. Provider business mailing address

7807 N JEFFERSON PLACE CIR APT D
BATON ROUGE LA
70809-8632
US

V. Phone/Fax

Practice location:
  • Phone: 225-761-5200
  • Fax: 225-761-5549
Mailing address:
  • Phone: 602-228-3099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number200867
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: