Healthcare Provider Details

I. General information

NPI: 1477983062
Provider Name (Legal Business Name): HEALTHCARE DIMENSIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 LOUISIANA AVE
OPELOUSAS LA
70570-3346
US

IV. Provider business mailing address

226 LOUISIANA AVE
OPELOUSAS LA
70570-3346
US

V. Phone/Fax

Practice location:
  • Phone: 337-678-1630
  • Fax: 337-678-1635
Mailing address:
  • Phone: 337-678-1630
  • Fax: 337-678-1635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. PAMELA JACKSON
Title or Position: OWNER/NURSE PRACTITIONER
Credential: DNP
Phone: 337-678-1630