Healthcare Provider Details

I. General information

NPI: 1730808866
Provider Name (Legal Business Name): SOUTHERN SPROUTS PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1268 SOUTHAMPTON DR
ALEXANDRIA LA
71303-3036
US

IV. Provider business mailing address

1268 SOUTHAMPTON DR
ALEXANDRIA LA
71303-3036
US

V. Phone/Fax

Practice location:
  • Phone: 318-777-6887
  • Fax: 318-545-5226
Mailing address:
  • Phone: 318-777-6887
  • Fax: 318-545-5226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: HEATHER RENEE RACHAL
Title or Position: NURSE PRACTITIONER/CO-OWNER
Credential: NP
Phone: 318-729-4265