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Organization
WHITE CLOVER, LLC
Active
Organization
WHITE CLOVER, LLC
Active
Other names
White Clover Wellness & Research Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TAMARA M SMITH (CFO)
(318) 455-8856
Entity
Organization
Contact information
Practice address
460 ASHLEY RIDGE BLVD, STE 600, SHREVEPORT, LA 71106-7235
(318) 861-4226
Mailing address
460 ASHLEY RIDGE BLVD, STE 600, SHREVEPORT, LA 71106-7235
(318) 861-4226
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
NULL
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
10/16/2015
Last updated
01/26/2016
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