| NPI | 1932689965 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA K ROBERTS Billing Manager 318-381-4759 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: LA F0806153) |
| Enumeration Date | 2018-08-20 |
| Last Update Date | 2018-08-20 |