Provider Demographics
NPI:1497124325
Name:CASSELBERRY, ELIZABETH KEYS (NP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:KEYS
Last Name:CASSELBERRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:CLAIRE
Other - Last Name:KEYS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:2051 SILVERSIDE DR
Mailing Address - Street 2:STE 260
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-9005
Mailing Address - Country:US
Mailing Address - Phone:225-490-6301
Mailing Address - Fax:225-765-9539
Practice Address - Street 1:5131 ODONOVAN DR
Practice Address - Street 2:STE 300
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4782
Practice Address - Country:US
Practice Address - Phone:225-765-7778
Practice Address - Fax:225-765-7754
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08524363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health