Provider Demographics
NPI:1396880431
Name:READORE, GINA V (PA)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:V
Last Name:READORE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1023 ABDALLA BLVD
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-5869
Mailing Address - Country:US
Mailing Address - Phone:337-407-1547
Mailing Address - Fax:
Practice Address - Street 1:3975 INTERSTATE 49 S SERVICE RD
Practice Address - Street 2:STE 201
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-0775
Practice Address - Country:US
Practice Address - Phone:337-407-2795
Practice Address - Fax:337-407-2798
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LATPA174363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1449627Medicaid