Healthcare Provider Details

I. General information

NPI: 1154359867
Provider Name (Legal Business Name): JANET L MOREHOUSE MD AND WILLIS-KNIGHTON MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 BURT BLVD SUITE A
BENTON LA
71006-4900
US

IV. Provider business mailing address

PO BOX 1058
BENTON LA
71006-1058
US

V. Phone/Fax

Practice location:
  • Phone: 318-965-1795
  • Fax: 318-965-5505
Mailing address:
  • Phone: 318-965-1795
  • Fax: 318-965-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GREG J GAVIN
Title or Position: NETWORK ADMINISTRATOR
Credential:
Phone: 318-965-1795