Healthcare Provider Details

I. General information

NPI: 1073005435
Provider Name (Legal Business Name): WOMANS OUTPATIENT CLINIC PROVIDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 06/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 RUE DE LA VIE ST STE 407
BATON ROUGE LA
70817-5128
US

IV. Provider business mailing address

100 WOMANS WAY
BATON ROUGE LA
70817-5100
US

V. Phone/Fax

Practice location:
  • Phone: 225-215-7960
  • Fax: 225-922-3381
Mailing address:
  • Phone: 225-215-7960
  • Fax: 225-922-3381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP09920
License Number StateLA

VIII. Authorized Official

Name: MS. TERI FONTENOT
Title or Position: CEO
Credential:
Phone: 225-927-1300