Healthcare Provider Details

I. General information

NPI: 1275449258
Provider Name (Legal Business Name): GERMEQUA HARDMON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 E CRAIG ST
TALLULAH LA
71282-3718
US

IV. Provider business mailing address

402 E CRAIG ST
TALLULAH LA
71282-3718
US

V. Phone/Fax

Practice location:
  • Phone: 318-574-9009
  • Fax:
Mailing address:
  • Phone: 318-574-9009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number770641488
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: