Healthcare Provider Details

I. General information

NPI: 1922650779
Provider Name (Legal Business Name): KHERRA MADISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 TOWER DR STE B
MONROE LA
71201-5045
US

IV. Provider business mailing address

2101 TOWER DR STE B
MONROE LA
71201-5045
US

V. Phone/Fax

Practice location:
  • Phone: 318-570-5400
  • Fax: 318-570-5403
Mailing address:
  • Phone: 318-570-5400
  • Fax: 318-570-5403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: