=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699529362
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE REDSTICK CLINIC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2024
-----------------------------------------------------
Last Update Date | 06/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4600 SHERWOOD COMMON BLVD STE 403
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70816-4890
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-218-4816
-----------------------------------------------------
Fax | 225-302-5057
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4600 SHERWOOD COMMON BLVD STE 403
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70816-4890
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-218-4816
-----------------------------------------------------
Fax | 225-302-5057
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. REBECCA DAVIS
-----------------------------------------------------
Credential | DNP, APRN
-----------------------------------------------------
Telephone | 225-218-4816
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------