Healthcare Provider Details

I. General information

NPI: 1659012722
Provider Name (Legal Business Name): SAID M MOHAMMAD APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 PERKINS RD
BATON ROUGE LA
70808-4373
US

IV. Provider business mailing address

7373 PERKINS RD
BATON ROUGE LA
70808-4373
US

V. Phone/Fax

Practice location:
  • Phone: 225-246-9790
  • Fax: 225-246-9160
Mailing address:
  • Phone: 225-246-9790
  • Fax: 225-246-9160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number221592
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number221592
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: