Healthcare Provider Details

I. General information

NPI: 1902798408
Provider Name (Legal Business Name): ADRIEN RIDOUT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 BERT KOUNS INDUSTRIAL LOOP STE K&L
SHREVEPORT LA
71118-3351
US

IV. Provider business mailing address

14461 HIGHWAY 157
BENTON LA
71006-4429
US

V. Phone/Fax

Practice location:
  • Phone: 318-688-3350
  • Fax: 866-554-1862
Mailing address:
  • Phone: 318-517-2311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number241668
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number241668
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number241668
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number241668
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: