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General NPI Number Information
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NPI Number | 1578333639
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Entity Type | Organization
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Legal Business Name | PEACOCK PRIMARY CARE, LLC
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Dates
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Enumeration Date | 01/08/2024
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 426 GOLDSBERRY CIR
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City | SHREVEPORT
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State | LA
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Zip | 71106-8346
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Country | US
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Telephone | 318-510-3943
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Fax | 888-366-9528
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Provider Business Mailing Address
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Address Line | 426 GOLDSBERRY CIR
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City | SHREVEPORT
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State | LA
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Zip | 71106-8346
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Country | US
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Telephone | 318-510-3943
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Fax | 888-366-9528
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Authorized Official
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Title or Position | OWNER
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Name | MS. BRANDY PEACOCK
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Credential | MSN, APRN, FNP-BS
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Telephone | 318-510-3943
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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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