Healthcare Provider Details

I. General information

NPI: 1407780174
Provider Name (Legal Business Name): GRACE GOSSERAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 PRESCOTT RD STE 101
ALEXANDRIA LA
71301-3917
US

IV. Provider business mailing address

14332 PATIN DYKE RD
VENTRESS LA
70783-4100
US

V. Phone/Fax

Practice location:
  • Phone: 318-528-5556
  • Fax: 318-944-6311
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number353319
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: