Healthcare Provider Details

I. General information

NPI: 1043201585
Provider Name (Legal Business Name): CELESTE CHILDRESS LUKE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 07/18/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 SHREVEPORT HWY
PINEVILLE LA
71360-4044
US

IV. Provider business mailing address

ALEXANDRIA VA HEALTH CARE SYSTEM 2495 SHREVEPORT HIGHWAY
PINEVILLE LA
71360-4044
US

V. Phone/Fax

Practice location:
  • Phone: 318-473-0010
  • Fax:
Mailing address:
  • Phone: 318-473-0010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number12539R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: