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General NPI Number Information
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NPI Number | 1447876289
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Entity Type | Organization
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Legal Business Name | HEADACHE CLINIC OF CENLA
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Dates
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Enumeration Date | 06/17/2020
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Last Update Date | 06/28/2021
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Provider Practice Location Address
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Address Line | 211 N 3RD ST STE A
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City | ALEXANDRIA
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State | LA
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Zip | 71301-8568
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Country | US
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Telephone | 318-625-7299
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Fax | 318-625-7169
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Provider Business Mailing Address
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Address Line | 211 N 3RD ST STE A
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City | ALEXANDRIA
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State | LA
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Zip | 71301-8568
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Country | US
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Telephone | 318-625-7299
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Fax | 318-625-7169
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ASHLEY MASON
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Credential |
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Telephone | 318-664-1817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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