Healthcare Provider Details

I. General information

NPI: 1811304074
Provider Name (Legal Business Name): EKARA N WAFER-MENDENHALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 W 2ND ST
HOMER LA
71040-3221
US

IV. Provider business mailing address

611 W 2ND ST
HOMER LA
71040-3221
US

V. Phone/Fax

Practice location:
  • Phone: 318-265-4542
  • Fax: 318-550-4271
Mailing address:
  • Phone: 318-265-4542
  • Fax: 318-550-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP07981
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN125342
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: