Healthcare Provider Details

I. General information

NPI: 1346209921
Provider Name (Legal Business Name): CHERILYNNE TONI COTTLES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 BREAZEALE SPRINGS ST
NATCHITOCHES LA
71457-4278
US

IV. Provider business mailing address

PO BOX 7422
NATCHITOCHES LA
71457-0422
US

V. Phone/Fax

Practice location:
  • Phone: 318-352-9299
  • Fax: 318-356-9546
Mailing address:
  • Phone: 504-259-4541
  • Fax: 318-356-9546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.016920
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: