MEDICARE: LINCOLN MEDICAL CLINIC 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	:	1295123081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINCOLN MEDICAL CLINIC LLC

Provider Business Mailing Address
First Line	:	1831 NORTH TRENTON STREET
Second Line	:	SUITE 2
City	:	RUSTON
State	:	LA
Zip	:	71270-2678
Country	:	US
Telephone Number	:	318-224-7004
Fax Number	:	318-224-7006

Provider Business Practice Location Address
First Line	:	1831 NORTH TRENTON STREET
Second Line	:	SUITE 2
City	:	RUSTON
State	:	LA
Zip	:	71270-2678
Country	:	US
Telephone Number	:	318-224-7004
Fax Number	:	318-224-7006

Authorized Official
Title or Position	:	OWNER
Name	:	BONNIE JENNIFER SHERRARD
Credential	:	APRN
Telephone Number	:	318-224-7004

Provider Enumeration Date	:	12/31/2014
Last Update Date	:	12/31/2014

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