Healthcare Provider Details

I. General information

NPI: 1023115250
Provider Name (Legal Business Name): NESOM FAMILY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E 6TH AVE
OAKDALE LA
71463-2628
US

IV. Provider business mailing address

400 E 6TH AVE
OAKDALE LA
71463-2628
US

V. Phone/Fax

Practice location:
  • Phone: 318-335-4881
  • Fax: 318-335-4544
Mailing address:
  • Phone: 318-335-4881
  • Fax: 318-335-4544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateLA

VIII. Authorized Official

Name: DR. AARON LOUIS LIRETTE
Title or Position: OWNER/PARTNER
Credential: MD
Phone: 318-335-4881