# COUNTRY CLINIC, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609825892
- **Authorized official:** MRS. ROSE KUPLESKY RN (OWNER/MANAGER)
- **Authorized official phone:** (318) 941-2057

## Contact information

- **Practice address:** 314 CHRISTINE LN, SIMMESPORT, LA 71369-2256
- **Practice address phone:** (318) 941-2057
- **Practice address fax:** (318) 941-2067
- **Mailing address:** PO BOX 80735, LAFAYETTE, LA 70598-0735
- **Mailing address phone:** (800) 564-8971
- **Mailing address fax:** (866) 693-1704

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 025398 | LA | Yes |

## Other

- **Enumeration date:** 05/08/2006
- **Last updated:** 11/13/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1445665 | — | LA |