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General NPI Number Information
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NPI Number | 1881931152
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Entity Type | Organization
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Legal Business Name | SLAINTE FAMILY CLINIC LLC
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Dates
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Enumeration Date | 01/07/2013
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Last Update Date | 01/27/2015
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Provider Practice Location Address
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Address Line | 188 BURT BLVD
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City | BENTON
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State | LA
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Zip | 71006-4900
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Country | US
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Telephone | 318-965-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 121 GATES DR
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City | BENTON
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State | LA
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Zip | 71006-4119
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Country | US
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Telephone | 318-518-8329
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Fax |
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Authorized Official
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Title or Position | SOLE OWNER
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Name | MS. PAULA WEAVER GATES
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Credential | APRN FNP-C
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Telephone | 318-518-8329
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP07052
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License Number State | LA
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