Healthcare Provider Details

I. General information

NPI: 1124461082
Provider Name (Legal Business Name): THE DIABETES CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 W CALIFORNIA AVE
RUSTON LA
71270-4911
US

IV. Provider business mailing address

823 W CALIFORNIA AVE
RUSTON LA
71270-4911
US

V. Phone/Fax

Practice location:
  • Phone: 318-224-3044
  • Fax: 318-232-2978
Mailing address:
  • Phone: 318-224-3044
  • Fax: 318-232-2978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP06647
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2390
License Number StateLA

VIII. Authorized Official

Name: ASHLEA LAUREN HILL
Title or Position: OWNER
Credential: FNP-C
Phone: 318-224-3044