Healthcare Provider Details

I. General information

NPI: 1881065647
Provider Name (Legal Business Name): KATIE VAN HOOF PETERSON SA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 PRESCOTT RD STE 202
ALEXANDRIA LA
71301-3983
US

IV. Provider business mailing address

3311 PRESCOTT RD STE 202
ALEXANDRIA LA
71301-3983
US

V. Phone/Fax

Practice location:
  • Phone: 318-442-0106
  • Fax: 318-448-8918
Mailing address:
  • Phone: 318-442-0106
  • Fax: 318-448-8918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: