Healthcare Provider Details

I. General information

NPI: 1952519639
Provider Name (Legal Business Name): ROSALES CHILDREN'S CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 01/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 CONTEMPO AVE
WEST MONROE LA
71291-7366
US

IV. Provider business mailing address

104 CONTEMPO AVE
WEST MONROE LA
71291-5312
US

V. Phone/Fax

Practice location:
  • Phone: 318-338-3585
  • Fax: 318-338-3588
Mailing address:
  • Phone: 318-807-1360
  • Fax: 318-807-1364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN070425 AP03721
License Number StateLA

VIII. Authorized Official

Name: MRS. KIMBERLI D SHOWS
Title or Position: OFFICE MANAGER
Credential:
Phone: 318-338-3585