Healthcare Provider Details

I. General information

NPI: 1952796450
Provider Name (Legal Business Name): EMILY HUSTED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 KINGS HWY
SHREVEPORT LA
71103-4228
US

IV. Provider business mailing address

3859 BALTIMORE AVE
SHREVEPORT LA
71106-1005
US

V. Phone/Fax

Practice location:
  • Phone: 318-675-8600
  • Fax: 318-675-8601
Mailing address:
  • Phone: 318-675-8600
  • Fax: 318-675-8601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: