Healthcare Provider Details

I. General information

NPI: 1437258043
Provider Name (Legal Business Name): PRIMARY CARE PROVIDERS FOR A HEALTHY FELICIANA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 04/12/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3619 HIGHWAY 10
JACKSON LA
70748
US

IV. Provider business mailing address

P.O. BOX 395
CLINTON LA
70722-0395
US

V. Phone/Fax

Practice location:
  • Phone: 225-683-1360
  • Fax: 225-634-0005
Mailing address:
  • Phone: 225-683-5292
  • Fax: 225-683-1310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: CHRISTI C HUNT
Title or Position: CEO
Credential:
Phone: 225-683-5292