Basic Information
| Provider Information | |||||||||
| NPI: | 1588990535 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASTILLE | ||||||||
| FirstName: | ADRIENNE | ||||||||
| MiddleName: | ROSE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7777 HENNESSY BLVD STE 1008 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708084368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257660416 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7777 HENNESSY BLVD -- ER DEPT | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257658826 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2009 | ||||||||
| LastUpdateDate: | 06/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA.200326 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 2312707 | 05 | LA | MEDICAID |