Healthcare Provider Details

I. General information

NPI: 1922749571
Provider Name (Legal Business Name): JUDITH ELIZA THOMAS-GREGORY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 BREAZEALE SPRINGS ST
NATCHITOCHES LA
71457-4278
US

IV. Provider business mailing address

1640 BREAZEALE SPRINGS ST
NATCHITOCHES LA
71457-4278
US

V. Phone/Fax

Practice location:
  • Phone: 318-352-9299
  • Fax: 318-352-0203
Mailing address:
  • Phone: 318-352-9299
  • Fax: 318-352-0203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number224811
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: