Healthcare Provider Details

I. General information

NPI: 1386238525
Provider Name (Legal Business Name): PROVIDENCE PRIMARY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2021
Last Update Date: 02/08/2026
Certification Date: 02/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CHINABERRY DR STE 1002
BOSSIER CITY LA
71111-2463
US

IV. Provider business mailing address

1000 CHINABERRY DR STE 1002
BOSSIER CITY LA
71111-2463
US

V. Phone/Fax

Practice location:
  • Phone: 318-562-3911
  • Fax: 318-656-3761
Mailing address:
  • Phone: 318-562-3911
  • Fax: 318-656-3761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LINDSEY MARLOWE RODGERS
Title or Position: OWNER, NURSE PRACTITIONER
Credential: APRN
Phone: 318-562-3911