Healthcare Provider Details

I. General information

NPI: 1699818427
Provider Name (Legal Business Name): LUCIEL PRYOR-CORDES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US HEALTH CLINIC KUWAIT
APO AE
09366
US

IV. Provider business mailing address

US HEALTH CLINIC KUWAIT
APO AE
09366
US

V. Phone/Fax

Practice location:
  • Phone: 318-430-1798
  • Fax:
Mailing address:
  • Phone: 318-430-1798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: