Healthcare Provider Details

I. General information

NPI: 1003389628
Provider Name (Legal Business Name): PREMIER MEDICAL CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 SAINT CLAUDE AVE STE C
NEW ORLEANS LA
70117-6144
US

IV. Provider business mailing address

3405 SAINT CLAUDE AVE STE C
NEW ORLEANS LA
70117-6144
US

V. Phone/Fax

Practice location:
  • Phone: 504-662-3763
  • Fax: 504-662-3763
Mailing address:
  • Phone: 504-662-3763
  • Fax: 504-662-3763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PEARL M KING
Title or Position: OWNER
Credential:
Phone: 504-662-3763