Basic Information
| Provider Information | |||||||||
| NPI: | 1497124325 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASSELBERRY | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | KEYS | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KEYS | ||||||||
| OtherFirstName: | ELIZABETH | ||||||||
| OtherMiddleName: | CLAIRE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | NP | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2051 SILVERSIDE DR | ||||||||
| Address2: | STE 260 | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708089005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2254906301 | ||||||||
| FaxNumber: | 2257659539 | ||||||||
| Practice Location | |||||||||
| Address1: | 5131 ODONOVAN DR | ||||||||
| Address2: | STE 300 | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708084782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257657778 | ||||||||
| FaxNumber: | 2257657754 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2015 | ||||||||
| LastUpdateDate: | 04/21/2016 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | AP08524 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.