Healthcare Provider Details

I. General information

NPI: 1316307895
Provider Name (Legal Business Name): JULIE HEUDUCK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 LOOP RD STE C
WINNSBORO LA
71295-3341
US

IV. Provider business mailing address

PO BOX 1300
WINNSBORO LA
71295-1300
US

V. Phone/Fax

Practice location:
  • Phone: 318-435-4571
  • Fax:
Mailing address:
  • Phone: 318-435-9411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP08687
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: