Healthcare Provider Details

I. General information

NPI: 1710065834
Provider Name (Legal Business Name): LINDSAY STAFFORD FERRINGTON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 06/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 KINGS HWY UROLOGY DEPARTMENT
SHREVEPORT LA
71130-3932
US

IV. Provider business mailing address

1501 KINGS HWY UROLOGY DEPARTMENT
SHREVEPORT LA
71132-3932
US

V. Phone/Fax

Practice location:
  • Phone: 318-813-2775
  • Fax: 318-813-2755
Mailing address:
  • Phone: 318-813-2775
  • Fax: 318-813-2755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.200054
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: