Healthcare Provider Details

I. General information

NPI: 1144187907
Provider Name (Legal Business Name): CREDENTECH PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 ABIGAYLE ROW
SCOTT LA
70583-8909
US

IV. Provider business mailing address

137 RUE VILLAGE RD
MAURICE LA
70555-3453
US

V. Phone/Fax

Practice location:
  • Phone: 337-315-7927
  • Fax:
Mailing address:
  • Phone: 337-315-7927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TYLER STOUT
Title or Position: OWNER
Credential:
Phone: 337-315-7927