Healthcare Provider Details

I. General information

NPI: 1790073898
Provider Name (Legal Business Name): TONY RAY OGDEN APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 ROSS ST
OAK GROVE LA
71263-9798
US

IV. Provider business mailing address

706 ROSS ST
OAK GROVE LA
71263-9798
US

V. Phone/Fax

Practice location:
  • Phone: 318-428-3237
  • Fax: 318-428-6180
Mailing address:
  • Phone: 318-428-3237
  • Fax: 318-428-6180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN094041-AP06529
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: