Healthcare Provider Details

I. General information

NPI: 1861237299
Provider Name (Legal Business Name): JULIE STROTHER MAHAFFEY WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 07/14/2024
Certification Date: 07/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 W 5TH ST
DERIDDER LA
70634-4856
US

IV. Provider business mailing address

PO BOX 730
DERIDDER LA
70634-0730
US

V. Phone/Fax

Practice location:
  • Phone: 337-462-7160
  • Fax:
Mailing address:
  • Phone: 337-404-1708
  • Fax: 337-404-1709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number236150
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: