Healthcare Provider Details

I. General information

NPI: 1578137782
Provider Name (Legal Business Name): CHRISTUS HEALTH CENTRAL LOUISIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 MARVEL ST
COUSHATTA LA
71019-9022
US

IV. Provider business mailing address

PO BOX 847329
DALLAS TX
75284-7329
US

V. Phone/Fax

Practice location:
  • Phone: 318-932-2168
  • Fax: 318-932-2186
Mailing address:
  • Phone: 800-756-7999
  • Fax: 469-282-1791

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 Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MONTE WILSON
Title or Position: CEO
Credential:
Phone: 337-470-2100