Healthcare Provider Details

I. General information

NPI: 1437370335
Provider Name (Legal Business Name): HOUMA HEALTH CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 BAYOU GARDENS BLVD
HOUMA LA
70364-1464
US

IV. Provider business mailing address

827 BAYOU GARDENS BLVD
HOUMA LA
70364-1464
US

V. Phone/Fax

Practice location:
  • Phone: 985-853-2343
  • Fax: 985-853-0589
Mailing address:
  • Phone: 985-853-2343
  • Fax: 985-853-0589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number14187R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number40568-4796
License Number StateLA

VIII. Authorized Official

Name: DR. PATRICK DECOURCY WALKER
Title or Position: CEO-OWNER
Credential: M.D.
Phone: 985-853-2343