Healthcare Provider Details

I. General information

NPI: 1558151357
Provider Name (Legal Business Name): DEVI MEGHANA KOTHARU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 JACKSON STREET, ST. FRANCIS MEDICAL CENTER
MONROE LA
71201
US

IV. Provider business mailing address

309 JACKSON STREET, ST. FRANCIS MEDICAL CENTER
MONROE LA
71201
US

V. Phone/Fax

Practice location:
  • Phone: 318-966-7172
  • Fax: 318-966-8788
Mailing address:
  • Phone: 318-966-7172
  • Fax: 318-966-8788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: