MEDICARE: CASTING CARE 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	:	1295492999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASTING CARE CLINIC LLC

Provider Business Mailing Address
First Line	:	5412 SUSANNA DR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71112-4944
Country	:	US
Telephone Number	:	318-401-1432
Fax Number	:

Provider Business Practice Location Address
First Line	:	7840 JEWELLA AVE
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71108-5004
Country	:	US
Telephone Number	:	318-401-1432
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LASONYA JONES
Credential	:	NP
Telephone Number	:	318-401-1432

Provider Enumeration Date	:	11/17/2021
Last Update Date	:	11/23/2021

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Directions to “CASTING CARE CLINIC LLC ” Practice Location

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