Healthcare Provider Details

I. General information

NPI: 1255826897
Provider Name (Legal Business Name): THRESA CAUGHMAN WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: THRESA A HARGRAVE

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2449 HOSPITAL DR STE 260
BOSSIER CITY LA
71111-1909
US

IV. Provider business mailing address

2449 HOSPITAL DR STE 260
BOSSIER CITY LA
71111-1909
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-7840
  • Fax: 318-212-7845
Mailing address:
  • Phone: 318-212-7840
  • Fax: 318-212-7845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP10091
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: