| NPI | 1679042287 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WANDA G SMITH Provider 318-325-7998 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2022-08-04 |