Healthcare Provider Details

I. General information

NPI: 1154319762
Provider Name (Legal Business Name): RENAL ASSOCIATES OF NORTHEAST LOUISIANA APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 THOMAS RD STE 1
WEST MONROE LA
71292-7903
US

IV. Provider business mailing address

401 THOMAS RD STE 1
WEST MONROE LA
71292-7903
US

V. Phone/Fax

Practice location:
  • Phone: 318-325-5435
  • Fax: 318-325-5495
Mailing address:
  • Phone: 318-325-5435
  • Fax: 318-325-5495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: NELSON YOUNT
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 318-325-5435