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General NPI Number Information
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NPI Number | 1184053340
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Entity Type | Organization
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Legal Business Name | PELICAN PEDIATRICS, LLC
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Dates
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Enumeration Date | 11/07/2013
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Last Update Date | 10/01/2014
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Provider Practice Location Address
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Address Line | 911 W MAIN ST SUITE C
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City | HOMER
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State | LA
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Zip | 71040-3300
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Country | US
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Telephone | 318-927-3255
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Fax | 318-927-3257
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Provider Business Mailing Address
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Address Line | 911 W MAIN ST SUITE C
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City | HOMER
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State | LA
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Zip | 71040-3300
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Country | US
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Telephone | 318-927-3255
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Fax | 318-927-3257
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Authorized Official
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Title or Position | OWNER, MANAGER
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Name | MRS. LESLIE COUVILLON BRASHER
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Credential | APRN, CPNP
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Telephone | 318-927-3255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | APO5536
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 2203781980
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License Number State | LA
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