| NPI | 1316819832 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER STOUT Office Manager 337-315-7927 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2025-09-23 |
| Last Update Date | 2025-09-23 |