Healthcare Provider Details

I. General information

NPI: 1790399269
Provider Name (Legal Business Name): SUMMER DENISE FRAZIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 PINES RD STE 1115
SHREVEPORT LA
71129-3900
US

IV. Provider business mailing address

16704 HIGHWAY 80
MINDEN LA
71055-6406
US

V. Phone/Fax

Practice location:
  • Phone: 318-683-4086
  • Fax: 318-683-4087
Mailing address:
  • Phone: 318-707-1557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: