Provider Demographics
NPI:1417250846
Name:TATE, KEVIN J (ARDMS RVT RCS ARRT)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:J
Last Name:TATE
Suffix:
Gender:M
Credentials:ARDMS RVT RCS ARRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 GRANT RD
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-0745
Mailing Address - Country:US
Mailing Address - Phone:337-945-4953
Mailing Address - Fax:866-390-5469
Practice Address - Street 1:335 GRANT RD
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-0745
Practice Address - Country:US
Practice Address - Phone:337-945-4953
Practice Address - Fax:866-390-5469
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA81840246XS1301X
LA000269852471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography