Healthcare Provider Details

I. General information

NPI: 1184750044
Provider Name (Legal Business Name): STEPHEN CRAIG MCCANN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 09/30/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5390 BARKSDALE BLVD STE 100
BOSSIER CITY LA
71112-4526
US

IV. Provider business mailing address

2539 VIKING DR STE 101
BOSSIER CITY LA
71111-2165
US

V. Phone/Fax

Practice location:
  • Phone: 318-747-8105
  • Fax: 318-747-8150
Mailing address:
  • Phone: 183-747-8100
  • Fax: 183-747-8150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number221908
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: