| NPI | 1124772009 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OCTAVIA GREEN Administrative Program Specialist B 318-362-3270 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family |
| Enumeration Date | 2022-02-09 |
| Last Update Date | 2023-08-30 |