=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881364057
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLEAR RESULTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2021
-----------------------------------------------------
Last Update Date | 09/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 CHEROKEE TRL
-----------------------------------------------------
City | DELHI
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71232-5703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-334-3634
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 CHEROKEE TRL
-----------------------------------------------------
City | DELHI
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71232-5703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-334-3634
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MIA MCCALL
-----------------------------------------------------
Credential | NURSE PRACTITIONER
-----------------------------------------------------
Telephone | 318-334-3634
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------