=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699659326
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY DEANNA TASSIN PHYSICIAN ASSISTANT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2025
-----------------------------------------------------
Last Update Date | 10/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4150 NELSON RD STE D1
-----------------------------------------------------
City | LAKE CHARLES
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70605-4133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-508-1000
-----------------------------------------------------
Fax | 337-335-0701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 501 DR MICHAEL DEBAKEY DR
-----------------------------------------------------
City | LAKE CHARLES
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70601-5724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-312-8360
-----------------------------------------------------
Fax | 337-312-6708
-----------------------------------------------------
=====================================================
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 | 349489
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------