Healthcare Provider Details

I. General information

NPI: 1639617103
Provider Name (Legal Business Name): LIL SPROUTS PEDIATRICS & FAMILY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2017
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 BELL LANE STE C & D
WEST MONROE LA
71291-1348
US

IV. Provider business mailing address

206 BELL LN STE C & D
WEST MONROE LA
71291-6300
US

V. Phone/Fax

Practice location:
  • Phone: 318-310-5840
  • Fax:
Mailing address:
  • Phone: 318-310-5840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOANIE LYNN GRAVES
Title or Position: MANAGER
Credential: APRN
Phone: 318-310-5840