Healthcare Provider Details

I. General information

NPI: 1023980075
Provider Name (Legal Business Name): HEATHER VOGEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 KINGS HWY
SHREVEPORT LA
71103-4228
US

IV. Provider business mailing address

2640 COUNTRY CLUB RD STE 400
LAKE CHARLES LA
70605-6079
US

V. Phone/Fax

Practice location:
  • Phone: 337-515-2538
  • Fax:
Mailing address:
  • Phone: 337-426-0919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number349593
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: