NPI |
1942664123 |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Entity Type Code |
1 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Provider Last Name Legal Name |
HENDERSON |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Provider First Name |
MARQUITHA |
The first name of the provider, if the provider
is an individual. |
Provider First Line Business Practice Location Address |
862 ONEAL LN |
The first name of the provider, if the provider
is an individual. |
Provider Business Practice Location Address City Name |
BATON ROUGE |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
LA |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address Postal Code |
70816 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
2252753039 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Fax Number |
2252759086 |
The fax number associated with the location
address of the provider being identified. |
Provider Enumeration Date |
4/13/2016 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
7/2/2018 |
The date that a record was last updated or changed. |
Provider Gender Code |
F |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Taxonomy Code 1 |
101Y00000X |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Primary Taxonomy Switch 1 |
N |
|
Healthcare Provider Taxonomy Code 2 |
171M00000X |
|
Healthcare Provider Primary Taxonomy Switch 2 |
Y |
|
Is Sole Proprietor |
Y |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |