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General NPI Number Information
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NPI Number | 1730808866
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Entity Type | Organization
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Legal Business Name | SOUTHERN SPROUTS PEDIATRICS, LLC
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Dates
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Enumeration Date | 08/23/2022
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 1268 SOUTHAMPTON DR
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City | ALEXANDRIA
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State | LA
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Zip | 71303-3036
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Country | US
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Telephone | 318-777-6887
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Fax | 318-545-5226
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Provider Business Mailing Address
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Address Line | 1268 SOUTHAMPTON DR
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City | ALEXANDRIA
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State | LA
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Zip | 71303-3036
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Country | US
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Telephone | 318-777-6887
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Fax | 318-545-5226
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Authorized Official
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Title or Position | NURSE PRACTITIONER/CO-OWNER
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Name | HEATHER RENEE RACHAL
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Credential | NP
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Telephone | 318-729-4265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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