Provider Demographics
NPI:1760763650
Name:DALE TATE, FNP, LLC
Entity Type:Organization
Organization Name:DALE TATE, FNP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:TATE
Authorized Official - Suffix:JR
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:985-229-4114
Mailing Address - Street 1:75136 N RIVER RD
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:LA
Mailing Address - Zip Code:70444-3800
Mailing Address - Country:US
Mailing Address - Phone:985-229-4114
Mailing Address - Fax:
Practice Address - Street 1:2004 J MARVIN MAGEE DR
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-9799
Practice Address - Country:US
Practice Address - Phone:985-839-3555
Practice Address - Fax:985-839-6320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06135363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty