MEDICARE: ANNIE CLAIRE CASTILLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1164283586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNIE CLAIRE CASTILLE

Provider Business Mailing Address
First Line	:	1919 7TH AVE S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35233-2005
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	309 RENWOOD CIR
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-5025
Country	:	US
Telephone Number	:	337-446-1567
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2024
Last Update Date	:	01/22/2024

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Directions to “ ANNIE CLAIRE CASTILLE ” Practice Location

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