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General NPI Number Information
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NPI Number | 1710599089
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Entity Type | Organization
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Legal Business Name | ELITE HEALTHCARE PROVIDERS
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Dates
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Enumeration Date | 08/18/2020
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 4021 WE HECK CT STE E4
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City | BATON ROUGE
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State | LA
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Zip | 70816-0417
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Country | US
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Telephone | 225-716-5264
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 239
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City | SAINT GABRIEL
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State | LA
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Zip | 70776-0239
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Country | US
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Telephone | 225-716-5264
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Fax |
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Authorized Official
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Title or Position | CEO/COOWNER
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Name | MS. APRIL JACKSON
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Credential | FNP
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Telephone | 225-716-5264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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