Healthcare Provider Details

I. General information

NPI: 1811536493
Provider Name (Legal Business Name): CHARMETTA KAY NASH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2019
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 JONES ST
RAYVILLE LA
71269-2323
US

IV. Provider business mailing address

4308 S GRAND ST
MONROE LA
71202-6322
US

V. Phone/Fax

Practice location:
  • Phone: 318-297-1199
  • Fax:
Mailing address:
  • Phone: 318-297-1199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: