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NPI Code Detail

MEDICARE: SEASONS PRIMARY CARE

MEDICARE: SEASONS PRIMARY CARE
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
1364SF0001XFamily Health Clinical Nurse SpecialistAP06950LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1094105OTHERLARN
2AP06950OTHERLANURSE PRACTITIONER

General Provider Information

NPI Number : 1245588300
Entity Type Code : Organization
Provider Name (Legal Business Name) : SEASONS PRIMARY CARE
Provider Business Mailing Address
First Line : 1809 NORTHPOINTE LN
Second Line : SUITE 203
City : RUSTON
State : LA
Zip : 71270-3853
Country : US
Telephone Number : 318-255-7591
Fax Number : 318-255-7584
Provider Business Practice Location Address
First Line : 1809 NORTHPOINTE LN
Second Line : SUITE 203
City : RUSTON
State : LA
Zip : 71270-3853
Country : US
Telephone Number : 318-255-7591
Fax Number : 318-255-7584
Authorized Official
Title or Position : CO-OWNER
Name : DAVID CASTON
Credential :
Telephone Number : 318-255-7591
Provider Enumeration Date : 08/21/2012
Last Update Date : 08/21/2012

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