Healthcare Provider Details

I. General information

NPI: 1639234495
Provider Name (Legal Business Name): AHS WALK IN CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6011 AMBASSADOR CAFFERY PKWY
YOUNGSVILLE LA
70592-5170
US

IV. Provider business mailing address

6011 AMBASSADOR CAFFERY PKWY
YOUNGSVILLE LA
70592-5170
US

V. Phone/Fax

Practice location:
  • Phone: 337-234-9925
  • Fax: 337-235-3357
Mailing address:
  • Phone: 337-234-9925
  • Fax: 337-237-5211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLY PREJEAN
Title or Position: PROVIDER ENROLLMENT SPECIALIST
Credential: CPCS
Phone: 337-202-0720