| NPI | 1710790100 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER STOUT Manager 337-315-7927 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 363LF0000X Nurse Practitioner, Family | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2025-01-29 |
| Last Update Date | 2025-10-13 |