=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134452394
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA L ROY PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2009
-----------------------------------------------------
Last Update Date | 03/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8585 PICARDY AVE
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70809-3748
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-237-1810
-----------------------------------------------------
Fax | 225-763-4117
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 36139 WESTIN RIDGE DR
-----------------------------------------------------
City | GEISMAR
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70734-3437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-237-1810
-----------------------------------------------------
Fax | 225-763-4117
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA200271
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------