Healthcare Provider Details

I. General information

NPI: 1104703602
Provider Name (Legal Business Name): PRIMARY CARE PROVIDERS FOR A HEALTHY FELICIANA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48405 HIGHWAY 51
TICKFAW LA
70466-1915
US

IV. Provider business mailing address

PO BOX 395
CLINTON LA
70722-0395
US

V. Phone/Fax

Practice location:
  • Phone: 225-683-5292
  • Fax: 225-683-1310
Mailing address:
  • Phone: 225-683-5292
  • Fax: 225-683-1310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: CHRISTI C HUNT
Title or Position: CEO
Credential:
Phone: 225-683-5292