Healthcare Provider Details

I. General information

NPI: 1003548660
Provider Name (Legal Business Name): STEFANIE HARRIS CORLEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 4TH ST
ALEXANDRIA LA
71301-8421
US

IV. Provider business mailing address

PO BOX 1089
HAMMOND LA
70404-1089
US

V. Phone/Fax

Practice location:
  • Phone: 318-545-0655
  • Fax:
Mailing address:
  • Phone: 985-892-7070
  • Fax: 855-821-4499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number225888
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: