Healthcare Provider Details

I. General information

NPI: 1740700434
Provider Name (Legal Business Name): JAMES DANIEL HENDRICK FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16158 AIRLINE HWY STE 103
PRAIRIEVILLE LA
70769-4212
US

IV. Provider business mailing address

3745 MONTE VISTA DR
ADDIS LA
70710-3008
US

V. Phone/Fax

Practice location:
  • Phone: 225-963-9355
  • Fax:
Mailing address:
  • Phone: 225-603-1728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP09401
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: