Healthcare Provider Details

I. General information

NPI: 1902328370
Provider Name (Legal Business Name): MICHAEL ANTHONY SHOWERS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17536 RISING FAWN RD
AMITE LA
70422
US

IV. Provider business mailing address

17536 RISING FAWN RD
AMITE LA
70422-7436
US

V. Phone/Fax

Practice location:
  • Phone: 469-744-8357
  • Fax:
Mailing address:
  • Phone: 469-744-8357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: