Provider Demographics
NPI:1508262437
Name:PATEL, AMISHA (PA-C)
Entity Type:Individual
Prefix:
First Name:AMISHA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 62600 DEPT 1744
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70162-0001
Mailing Address - Country:US
Mailing Address - Phone:225-368-3200
Mailing Address - Fax:225-368-2280
Practice Address - Street 1:9118 BLUEBONNET CENTRE BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2993
Practice Address - Country:US
Practice Address - Phone:225-368-2300
Practice Address - Fax:225-368-2280
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200777363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2381121Medicaid
LA2381121Medicaid