Healthcare Provider Details

I. General information

NPI: 1396303145
Provider Name (Legal Business Name): TINA MARIE LAWHORN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2945 SHREVEPORT HWY
PINEVILLE LA
71360
US

IV. Provider business mailing address

2945 SHREVEPORT HWY
PINEVILLE LA
71360
US

V. Phone/Fax

Practice location:
  • Phone: 318-466-4000
  • Fax:
Mailing address:
  • Phone: 318-466-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number205923
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: