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General NPI Number Information
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NPI Number | 1558569764
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Entity Type | Individual
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Provider Name | PATRICE JENNE TYSON MD
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Gender | Female
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 10/25/2013
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Provider Practice Location Address
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Address Line | 7777 HENNESSY BLVD SUITE 409
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City | BATON ROUGE
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State | LA
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Zip | 70808-4300
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Country | US
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Telephone | 225-765-6834
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Fax | 225-765-2054
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Provider Business Mailing Address
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Address Line | 7777 HENNESSY BLVD SUITE 409
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City | BATON ROUGE
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State | LA
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Zip | 70808-4300
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Country | US
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Telephone | 225-765-6834
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Fax | 225-765-2054
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35090026
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | MD.025783
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD.025783
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License Number State | LA
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