Healthcare Provider Details

I. General information

NPI: 1164394490
Provider Name (Legal Business Name): MARRELL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 BEAGLE RUN
ALEXANDRIA LA
71303-8800
US

IV. Provider business mailing address

12 BEAGLE RUN
ALEXANDRIA LA
71303-8800
US

V. Phone/Fax

Practice location:
  • Phone: 504-858-5887
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: FARRYL WILBURN
Title or Position: PARTNER
Credential: PA-C
Phone: 504-858-5887