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General NPI Number Information
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NPI Number | 1407904600
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Entity Type | Organization
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Legal Business Name | DR K FOURNET ETALPTR
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Dates
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Enumeration Date | 01/07/2007
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Last Update Date | 03/02/2010
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Provider Practice Location Address
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Address Line | 406 N MAIN ST
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City | SAINT MARTINVILLE
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State | LA
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Zip | 70582-4119
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Country | US
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Telephone | 337-394-5507
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Fax | 337-394-5508
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Provider Business Mailing Address
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Address Line | 406 N MAIN ST
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City | SAINT MARTINVILLE
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State | LA
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Zip | 70582-4119
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Country | US
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Telephone | 337-394-5507
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Fax | 337-394-5508
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Authorized Official
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Title or Position | INSURANCE CLERK
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Name | MRS. BETTY C CHAMPAGNE
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Credential |
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Telephone | 337-394-5507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 7061
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License Number State | LA
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