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General NPI Number Information
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NPI Number | 1780170233
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Entity Type | Individual
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Provider Name | HEATHER MADDOX DUCOTE FNP
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Gender | Female
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Dates
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Enumeration Date | 07/09/2018
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Last Update Date | 07/09/2018
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Provider Practice Location Address
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Address Line | 122 MARYLAND AVE
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City | ALEXANDRIA
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State | LA
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Zip | 71301-5403
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Country | US
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Telephone | 318-628-0088
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Fax |
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Provider Business Mailing Address
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Address Line | 68 CAROLINE DR
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City | BOYCE
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State | LA
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Zip | 71409-9836
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP10084
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License Number State | LA
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