| NPI | 1679935928 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURIE DOSS Billing 318-665-9950 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: LA 2203781103) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA 2203781103) |
| Enumeration Date | 2016-03-25 |
| Last Update Date | 2016-12-05 |