Healthcare Provider Details

I. General information

NPI: 1053635987
Provider Name (Legal Business Name): NATCHITOCHES URGENT CARE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2010
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 BIENVILLE ST
NATCHITOCHES LA
71457-5730
US

IV. Provider business mailing address

100 MORGAN LN
NATCHITOCHES LA
71457-6077
US

V. Phone/Fax

Practice location:
  • Phone: 318-356-5566
  • Fax: 318-932-9906
Mailing address:
  • Phone: 318-332-2288
  • Fax: 318-932-9906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. LAVORA WILSON
Title or Position: OWNER/FNP
Credential: APRN
Phone: 318-332-8219