Healthcare Provider Details

I. General information

NPI: 1841172822
Provider Name (Legal Business Name): ARIELLE BRITTANIE LAMONT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 S FLEISHEL AVE
TYLER TX
75701-2015
US

IV. Provider business mailing address

2309 ASHLAND AVE
BOSSIER CITY LA
71111-2459
US

V. Phone/Fax

Practice location:
  • Phone: 903-595-2283
  • Fax:
Mailing address:
  • Phone: 318-516-9814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA19583
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: