Basic Information
| Provider Information | |||||||||
| NPI: | 1023399888 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | T & T KLICK, LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | FAMILY CARE CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 107 LELA ST | ||||||||
| Address2: | |||||||||
| City: | MANGHAM | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712595063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182484100 | ||||||||
| FaxNumber: | 3182484103 | ||||||||
| Practice Location | |||||||||
| Address1: | 107 LELA ST | ||||||||
| Address2: | |||||||||
| City: | MANGHAM | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712595063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182484100 | ||||||||
| FaxNumber: | 3182484103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2011 | ||||||||
| LastUpdateDate: | 10/20/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KLICK | ||||||||
| AuthorizedOfficialFirstName: | TERRI | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3182484100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | FNP-C | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | APO6543 | LA | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.