Healthcare Provider Details

I. General information

NPI: 1861583874
Provider Name (Legal Business Name): DETRIES R MORRIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4974 HIGHWAY 3276 STE C
STONEWALL LA
71078-9306
US

IV. Provider business mailing address

4974 HIGHWAY 3276 STE C
STONEWALL LA
71078-9306
US

V. Phone/Fax

Practice location:
  • Phone: 318-681-4500
  • Fax: 318-681-4356
Mailing address:
  • Phone: 318-681-4500
  • Fax: 318-681-4356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP03499
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: