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General NPI Number Information
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NPI Number | 1093266629
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Entity Type | Organization
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Legal Business Name | INFINITY FAMILY HEALTH CLINIC, LLC
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Dates
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Enumeration Date | 10/19/2016
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 2034 MYRTLE ST.
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City | ARCADIA
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State | LA
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Zip | 71001
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Country | US
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Telephone | 318-325-6200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 38
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City | ARCADIA
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State | LA
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Zip | 71001-0038
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | BRITTNEY WHITLOCK
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Credential |
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Telephone | 318-325-6200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 04826
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License Number State | LA
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