Healthcare Provider Details

I. General information

NPI: 1003402876
Provider Name (Legal Business Name): DSD HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 HIGHWAY 167 N
BERNICE LA
71222-5117
US

IV. Provider business mailing address

2505 CYPRESS SPRINGS AVE
RUSTON LA
71270-5109
US

V. Phone/Fax

Practice location:
  • Phone: 318-243-0436
  • Fax:
Mailing address:
  • Phone: 318-243-0436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. SHRIEKA TAREASE EVANS
Title or Position: CEO
Credential: NP-C
Phone: 318-243-0436