Healthcare Provider Details

I. General information

NPI: 1144284662
Provider Name (Legal Business Name): LOUVIERE ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 CARRIAGE HOUSE DR STE D
JACKSON TN
38305
US

IV. Provider business mailing address

386 CARRIAGE HOUSE DR STE D
JACKSON TN
38305-2236
US

V. Phone/Fax

Practice location:
  • Phone: 731-664-8874
  • Fax: 731-664-8932
Mailing address:
  • Phone: 731-664-8874
  • Fax: 731-664-8932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. KELIA C INGRAM
Title or Position: OWNER PRESIDENT
Credential:
Phone: 731-664-8874