Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP08843 | LA |
NPI | 1003266479 |
---|---|
Provider Name | Mrs. Sarah Kilpatrick Wylie |
First Address | Baton Rouge, LA 70808-9143 |
Second Address | Baton Rouge, LA 70808-9143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2016 |
Last Update Date | 03/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
71-0916908 | TAX ID (01) | LA |