Healthcare Provider Details

I. General information

NPI: 1699529362
Provider Name (Legal Business Name): THE REDSTICK CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 SHERWOOD COMMON BLVD STE 403
BATON ROUGE LA
70816-4890
US

IV. Provider business mailing address

4600 SHERWOOD COMMON BLVD STE 403
BATON ROUGE LA
70816-4890
US

V. Phone/Fax

Practice location:
  • Phone: 225-218-4816
  • Fax: 225-302-5057
Mailing address:
  • Phone: 225-218-4816
  • Fax: 225-302-5057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. REBECCA DAVIS
Title or Position: OWNER
Credential: DNP, APRN
Phone: 225-218-4816