Basic Information
| Provider Information | |||||||||
| NPI: | 1801425855 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | SUMMER | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | APRN | ||||||||
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| OtherLastName: | ADAIR | ||||||||
| OtherFirstName: | SUMMER | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4615 GOVERNMENT ST BLDG 2 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708065922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259251906 | ||||||||
| FaxNumber: | 2253625319 | ||||||||
| Practice Location | |||||||||
| Address1: | 1112 E ASCENSION COMPLEX BLVD | ||||||||
| Address2: | |||||||||
| City: | GONZALES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707374265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2256215770 | ||||||||
| FaxNumber: | 2256443208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2020 | ||||||||
| LastUpdateDate: | 04/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 211939 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.