Healthcare Provider Details

I. General information

NPI: 1245588300
Provider Name (Legal Business Name): SEASONS PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2012
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 NORTHPOINTE LN SUITE 203
RUSTON LA
71270-3853
US

IV. Provider business mailing address

1809 NORTHPOINTE LN SUITE 203
RUSTON LA
71270-3853
US

V. Phone/Fax

Practice location:
  • Phone: 318-255-7591
  • Fax: 318-255-7584
Mailing address:
  • Phone: 318-255-7591
  • Fax: 318-255-7584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberAP06950
License Number StateLA

VIII. Authorized Official

Name: DAVID CASTON
Title or Position: CO-OWNER
Credential:
Phone: 318-255-7591