Healthcare Provider Details

I. General information

NPI: 1215273925
Provider Name (Legal Business Name): STEPHEN NAREMORE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2012
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 JACKSON ST EXT
ALEXANDRIA LA
71303-3002
US

IV. Provider business mailing address

3601 JACKSON ST EXT
ALEXANDRIA LA
71303-3002
US

V. Phone/Fax

Practice location:
  • Phone: 318-787-6877
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110004037
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number304717
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: