Provider Demographics
NPI:1285171074
Name:TEMPLE, RACHEL
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:TEMPLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4176
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70361-4176
Mailing Address - Country:US
Mailing Address - Phone:985-872-5864
Mailing Address - Fax:985-872-0317
Practice Address - Street 1:1102 CONSTITUTION AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4001
Practice Address - Country:US
Practice Address - Phone:601-282-8980
Practice Address - Fax:601-693-6561
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901951363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSAPPLIEDMedicaid
MS562478ZV7JMedicare UPIN