Healthcare Provider Details

I. General information

NPI: 1770293359
Provider Name (Legal Business Name): ALISHA BEDGOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 KEYSER AVE STE 120
NATCHITOCHES LA
71457-0039
US

IV. Provider business mailing address

733 KEYSER AVE STE 120
NATCHITOCHES LA
71457-0039
US

V. Phone/Fax

Practice location:
  • Phone: 318-238-4030
  • Fax:
Mailing address:
  • Phone: 318-238-4030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: