Healthcare Provider Details

I. General information

NPI: 1477080133
Provider Name (Legal Business Name): RONNIE CHARLES BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5229 W. ARBEED DRIVE
ST. JAMES LA
70086
US

IV. Provider business mailing address

7612 PICARDY AVE STE K
BATON ROUGE LA
70808-4353
US

V. Phone/Fax

Practice location:
  • Phone: 225-265-9759
  • Fax:
Mailing address:
  • Phone: 225-331-0032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: