=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982279907
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMBER MARIE BUCKHALTER HIS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2021
-----------------------------------------------------
Last Update Date | 05/21/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2102 MACARTHUR DR STE C
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71301-3763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-484-3755
-----------------------------------------------------
Fax | 318-484-3499
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2102 MACARTHUR DR STE C
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71301-3763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-484-3755
-----------------------------------------------------
Fax | 318-484-3499
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | HA-695
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------