Healthcare Provider Details

I. General information

NPI: 1942751201
Provider Name (Legal Business Name): JENA BAND OF CHOCTAW INDIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 LAPALI HINA ST
TROUT LA
71371-3508
US

IV. Provider business mailing address

906 LAPALI HINA ST
TROUT LA
71371-4115
US

V. Phone/Fax

Practice location:
  • Phone: 318-992-2763
  • Fax: 318-992-4162
Mailing address:
  • Phone: 318-992-2763
  • Fax: 318-217-2312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY KENNEY LILES
Title or Position: TRIBAL HEALTH ADMINISTRATOR
Credential:
Phone: 318-957-2800