Provider Demographics
NPI:1891938627
Name:MAYO, BRIANA (NP)
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:
Last Name:MAYO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 TARA BLVD
Mailing Address - Street 2:STE E
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-7818
Mailing Address - Country:US
Mailing Address - Phone:225-926-4400
Mailing Address - Fax:225-926-4409
Practice Address - Street 1:888 TARA BLVD
Practice Address - Street 2:STE E
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-7818
Practice Address - Country:US
Practice Address - Phone:225-926-4400
Practice Address - Fax:225-926-4409
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05743363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics