Healthcare Provider Details

I. General information

NPI: 1265782205
Provider Name (Legal Business Name): TIFFANY T HOUSER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64301 HIGHWAY 434
LACOMBE LA
70445-5411
US

IV. Provider business mailing address

64301 HIGHWAY 434
LACOMBE LA
70445-5411
US

V. Phone/Fax

Practice location:
  • Phone: 985-882-4500
  • Fax: 985-882-4501
Mailing address:
  • Phone: 985-882-4500
  • Fax: 985-882-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP06808
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: