Healthcare Provider Details

I. General information

NPI: 1417289711
Provider Name (Legal Business Name): ACCEPTANCE COMMUNITY CARE CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15142 MARY ELIZABETH DR
BATON ROUGE LA
70816-9043
US

IV. Provider business mailing address

15142 MARY ELIZABETH DR
BATON ROUGE LA
70816-9043
US

V. Phone/Fax

Practice location:
  • Phone: 225-382-3920
  • Fax: 225-382-3925
Mailing address:
  • Phone: 225-382-3920
  • Fax: 225-382-3925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP05942
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License NumberMD021278
License Number StateLA

VIII. Authorized Official

Name: MRS. SHARITA DAVIS ACKLIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 225-382-3920