Basic Information
Provider Information | |||||||||
NPI: | 1750613345 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GORIO | ||||||||
FirstName: | KARLA | ||||||||
MiddleName: | D | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PA-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BARRON | ||||||||
OtherFirstName: | KARLA | ||||||||
OtherMiddleName: | D | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PA-C | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1207 | ||||||||
Address2: |   | ||||||||
City: | GREENSBURG | ||||||||
State: | LA | ||||||||
PostalCode: | 704411207 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2252226059 | ||||||||
FaxNumber: | 2252226543 | ||||||||
Practice Location | |||||||||
Address1: | 490 SITMAN ST | ||||||||
Address2: |   | ||||||||
City: | GREENSBURG | ||||||||
State: | LA | ||||||||
PostalCode: | 704411207 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2252226059 | ||||||||
FaxNumber: | 2252226543 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/05/2010 | ||||||||
LastUpdateDate: | 01/08/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/08/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA.200301 | LA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
ID | Type | State | Issuer | Description | 2101129 | 05 | LA |   | MEDICAID |