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General NPI Number Information
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NPI Number | 1326836958
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Entity Type | Organization
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Legal Business Name | IN BETWEEN PCP AND MED-SPA INC
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Dates
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Enumeration Date | 04/25/2025
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 1732 LAKEFRONT DR
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City | SHREVEPORT
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State | LA
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Zip | 71119-3925
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Country | US
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Telephone | 318-294-8519
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Fax | 318-294-8519
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Provider Business Mailing Address
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Address Line | 1732 LAKEFRONT DR
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City | SHREVEPORT
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State | LA
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Zip | 71119-3925
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Country | US
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Telephone | 318-294-8519
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Fax | 318-294-8519
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Authorized Official
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Title or Position | OWNER
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Name | HUGHES, AREATHA HUGHES, AREATHA
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Credential | FNP-C
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Telephone | 318-294-8519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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