Healthcare Provider Details

I. General information

NPI: 1326655952
Provider Name (Legal Business Name): BRIAN GREGORY SERIO FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 WEBER ST
FRANKLIN LA
70538-4124
US

IV. Provider business mailing address

1115 WEBER ST
FRANKLIN LA
70538-4124
US

V. Phone/Fax

Practice location:
  • Phone: 337-828-2550
  • Fax: 337-828-5411
Mailing address:
  • Phone: 337-828-2550
  • Fax: 337-355-2335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number214936
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number214936
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: