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General NPI Number Information
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NPI Number | 1124893722
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Entity Type | Organization
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Legal Business Name | STRONG TOWER MEDICINE LLC
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Dates
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Enumeration Date | 11/24/2023
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Last Update Date | 12/27/2024
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Provider Practice Location Address
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Address Line | 34578 QUARTER HORSE LANE
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City | WALKER
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State | LA
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Zip | 70785
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Country | US
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Telephone | 225-281-9576
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Fax |
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Provider Business Mailing Address
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Address Line | 1113 S RANGE AVE STE 110
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City | DENHAM SPRINGS
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State | LA
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Zip | 70726-4899
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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 | SOLE MEMBER
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Name | TAYLOR MEADES
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Credential | NP-C
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Telephone | 225-281-9576
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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 |
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License Number State |
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