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NPI Code Detail

MEDICARE: MRS. STACY LYNN GREGORY LPN

MEDICARE: MRS. STACY LYNN GREGORY LPN
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
1164W00000XLicensed Practical Nurse291146LA

General Provider Information

NPI Number : 1558693127
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STACY LYNN GREGORY LPN
Provider Business Mailing Address
First Line : 949 OLIVE ST
Second Line :
City : SHREVEPORT
State : LA
Zip : 71104-2103
Country : US
Telephone Number : 318-222-3132
Fax Number : 318-222-3865
Provider Business Practice Location Address
First Line : 949 OLIVE ST
Second Line :
City : SHREVEPORT
State : LA
Zip : 71104-2103
Country : US
Telephone Number : 318-222-3132
Fax Number : 318-222-3865
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2010
Last Update Date : 02/08/2010

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