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General NPI Number Information
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NPI Number | 1811381072
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Entity Type | Organization
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Legal Business Name | CHENEVERT FAMILY CARE CLINIC, LLC
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Dates
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Enumeration Date | 03/26/2015
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Last Update Date | 04/21/2022
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Provider Practice Location Address
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Address Line | 501 FRONT ST
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City | CHENEYVILLE
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State | LA
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Zip | 71325-0385
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Country | US
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Telephone | 318-279-2300
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Fax | 318-279-2302
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Provider Business Mailing Address
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Address Line | PO BOX 385
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City | CHENEYVILLE
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State | LA
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Zip | 71325-0385
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Country | US
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Telephone | 318-279-2300
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Fax | 318-279-2302
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Authorized Official
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Title or Position | CEO/OWNER
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Name | CORA R CHENEVERT
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Credential | FNP-C
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Telephone | 318-279-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | AP07392
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License Number State | LA
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