Healthcare Provider Details

I. General information

NPI: 1780593475
Provider Name (Legal Business Name): PEYTON ROBERSON HARRISON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6569 HIGHWAY 84
FERRIDAY LA
71334-4573
US

IV. Provider business mailing address

283 TRAXLER RD
FERRIDAY LA
71334-4496
US

V. Phone/Fax

Practice location:
  • Phone: 318-757-6551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License Number209986
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: