Healthcare Provider Details

I. General information

NPI: 1245231026
Provider Name (Legal Business Name): PEARL ACRES PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59125 N PEARL DR
SLIDELL LA
70461-3727
US

IV. Provider business mailing address

59125 N PEARL DR
SLIDELL LA
70461-3727
US

V. Phone/Fax

Practice location:
  • Phone: 985-643-7927
  • Fax: 985-641-0209
Mailing address:
  • Phone: 985-643-7927
  • Fax: 985-641-0209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateLA

VIII. Authorized Official

Name: DR. CHERIE G OERTLING
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 985-643-7927