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NPI Code Detail

MEDICARE: LINCOLN MEDICAL CLINIC LLC

MEDICARE: LINCOLN MEDICAL CLINIC LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1295123081
Entity Type Code : Organization
Provider Name (Legal Business Name) : LINCOLN MEDICAL CLINIC LLC
Provider Business Mailing Address
First Line : 1831 NORTH TRENTON STREET
Second Line : SUITE 2
City : RUSTON
State : LA
Zip : 71270-2678
Country : US
Telephone Number : 318-224-7004
Fax Number : 318-224-7006
Provider Business Practice Location Address
First Line : 1831 NORTH TRENTON STREET
Second Line : SUITE 2
City : RUSTON
State : LA
Zip : 71270-2678
Country : US
Telephone Number : 318-224-7004
Fax Number : 318-224-7006
Authorized Official
Title or Position : OWNER
Name : BONNIE JENNIFER SHERRARD
Credential : APRN
Telephone Number : 318-224-7004
Provider Enumeration Date : 12/31/2014
Last Update Date : 12/31/2014

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Directions to “LINCOLN MEDICAL CLINIC LLC ” Practice Location

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