Basic Information
| Provider Information | |||||||||
| NPI: | 1841537214 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARGRODER | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | CHASE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8080 BLUEBONNET BLVD | ||||||||
| Address2: | SUITE 1000 | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708107827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259242424 | ||||||||
| FaxNumber: | 2254087984 | ||||||||
| Practice Location | |||||||||
| Address1: | 6550 MAIN ST | ||||||||
| Address2: | SUITE 2300 | ||||||||
| City: | ZACHARY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707914092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2256581808 | ||||||||
| FaxNumber: | 2256585922 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2013 | ||||||||
| LastUpdateDate: | 01/05/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 07129 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.