Healthcare Provider Details

I. General information

NPI: 1679393862
Provider Name (Legal Business Name): BRIGHT FUTURES PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 CALVERT DR STE D
ALEXANDRIA LA
71303-3520
US

IV. Provider business mailing address

41 CALVERT DR STE D
ALEXANDRIA LA
71303-3520
US

V. Phone/Fax

Practice location:
  • Phone: 318-443-9634
  • Fax: 318-443-9809
Mailing address:
  • Phone: 318-443-9634
  • Fax: 318-443-9809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JANE ANN BUSH
Title or Position: DIRECTOR
Credential: CPNP
Phone: 318-443-9634