Healthcare Provider Details

I. General information

NPI: 1750959284
Provider Name (Legal Business Name): MARY ELLEN HODGES BRAUD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 PARK ROWE AVE STE 200
BATON ROUGE LA
70810-1685
US

IV. Provider business mailing address

10101 PARK ROWE AVE STE 200
BATON ROUGE LA
70810-1685
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-3980
  • Fax: 833-756-2680
Mailing address:
  • Phone: 225-769-2200
  • Fax: 833-756-2680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number327807
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: