Healthcare Provider Details

I. General information

NPI: 1821630880
Provider Name (Legal Business Name): FLEUR DE LIS FAMILY HEALTHCARE OF CANKTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 MAIN ST
CANKTON LA
70584-5920
US

IV. Provider business mailing address

376 MAIN ST
CANKTON LA
70584-5920
US

V. Phone/Fax

Practice location:
  • Phone: 337-668-4141
  • Fax: 337-668-4386
Mailing address:
  • Phone: 337-668-4141
  • Fax: 337-668-4386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE SONNIER
Title or Position: OWNER
Credential:
Phone: 337-668-4141