MEDICARE: SOUTHERN SPROUTS PEDIATRICS, 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	2080P0203X	Pediatric Critical Care Medicine Physician
2	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730808866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN SPROUTS PEDIATRICS, LLC

Provider Business Mailing Address
First Line	:	1268 SOUTHAMPTON DR
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-3036
Country	:	US
Telephone Number	:	318-777-6887
Fax Number	:	318-545-5226

Provider Business Practice Location Address
First Line	:	1268 SOUTHAMPTON DR
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-3036
Country	:	US
Telephone Number	:	318-777-6887
Fax Number	:	318-545-5226

Authorized Official
Title or Position	:	NURSE PRACTITIONER/CO-OWNER
Name	:	HEATHER RENEE RACHAL
Credential	:	NP
Telephone Number	:	318-729-4265

Provider Enumeration Date	:	08/23/2022
Last Update Date	:	12/09/2025

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Directions to “SOUTHERN SPROUTS PEDIATRICS, LLC ” Practice Location

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