Healthcare Provider Details

I. General information

NPI: 1184074502
Provider Name (Legal Business Name): BILL CRANFORD JR. FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 PICARDY AVE
BATON ROUGE LA
70809-3685
US

IV. Provider business mailing address

PO BOX 4176
HOUMA LA
70361-4176
US

V. Phone/Fax

Practice location:
  • Phone: 225-308-0247
  • Fax: 225-308-0248
Mailing address:
  • Phone: 985-872-5864
  • Fax: 985-872-0317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP08849
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: