Healthcare Provider Details

I. General information

NPI: 1659816858
Provider Name (Legal Business Name): VELOCITY MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2016
Last Update Date: 12/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 KEYSER AVE
NATCHITOCHES LA
71457-5801
US

IV. Provider business mailing address

307 KEYSER AVE
NATCHITOCHES LA
71457-5801
US

V. Phone/Fax

Practice location:
  • Phone: 318-352-5221
  • Fax: 318-352-7757
Mailing address:
  • Phone: 318-352-5221
  • Fax: 318-352-7757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberMD.019455
License Number StateLA

VIII. Authorized Official

Name: KRISTIN GILLUM
Title or Position: DIRECTOR OF OVERSIGHT & MANAGEMENT
Credential:
Phone: 318-629-3763