Healthcare Provider Details

I. General information

NPI: 1245661487
Provider Name (Legal Business Name): CLAIRE HAMMOND PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CLAIRE MARIE CLARK PA

II. Dates (important events)

Enumeration Date: 12/12/2013
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 MANSFIELD RD SUITE 110
SHREVEPORT LA
71118-3155
US

IV. Provider business mailing address

46 LOUIS PRIMA DR STE A
COVINGTON LA
70433-5903
US

V. Phone/Fax

Practice location:
  • Phone: 318-629-3763
  • Fax: 318-629-3767
Mailing address:
  • Phone: 985-892-7070
  • Fax: 985-892-7017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number200680
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA08661
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.200680
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: