Provider Demographics
NPI:1669470472
Name:GOOTEE, MARY PATRICIA (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:PATRICIA
Last Name:GOOTEE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:PATRICIA
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1631 ELYSIAN FIELDS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70117
Mailing Address - Country:US
Mailing Address - Phone:504-821-2601
Mailing Address - Fax:504-814-6047
Practice Address - Street 1:1631 ELYSIAN FIELDS AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70117
Practice Address - Country:US
Practice Address - Phone:504-821-2601
Practice Address - Fax:504-814-6047
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA369991171363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1550493Medicaid
LA5X714Medicare PIN
LAS70615Medicare UPIN