MEDICARE: PROVISION HEALTH CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1134090061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVISION HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 510
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71294-0510
Country	:	US
Telephone Number	:	318-322-9252
Fax Number	:	318-322-2885

Provider Business Practice Location Address
First Line	:	525 W FAULKNER ST
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4518
Country	:	US
Telephone Number	:	870-337-2009
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	JACEY MELOY
Credential	:
Telephone Number	:	318-322-9252

Provider Enumeration Date	:	09/15/2025
Last Update Date	:	09/15/2025

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Directions to “PROVISION HEALTH CARE LLC ” Practice Location

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