Healthcare Provider Details

I. General information

NPI: 1861766537
Provider Name (Legal Business Name): LEALIA SKINNER-SAPP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2012
Last Update Date: 02/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 LESLIE LN
MONROE LA
71203-2783
US

IV. Provider business mailing address

7 LESLIE LN
MONROE LA
71203-2783
US

V. Phone/Fax

Practice location:
  • Phone: 318-789-8970
  • Fax:
Mailing address:
  • Phone: 318-789-8970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberAP06510
License Number StateLA

VIII. Authorized Official

Name: MS. LEALIA D SKINNER-SAPP
Title or Position: FAMILY NURSE PRACTITIONER
Credential: NP
Phone: 318-789-8970