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Organization
DESOTO HEALTHCARE CENTER INC.
Active
Organization
DESOTO HEALTHCARE CENTER INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CONNIE B GANNON FNP (FAMILY NURSE PRACTITIONER)
(318) 871-1633
Entity
Organization
Contact information
Practice address
938 LOUISE ST, MANSFIELD, LA 71052
(318) 871-1633
(318) 871-1677
Mailing address
PO BOX 1384, MANSFIELD, LA 71052-1384
(318) 871-1633
(318) 871-1677
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD199935
LA
207RN0300X
Nephrology Physician
1487481
LA
208000000X
Pediatrics Physician
1996971
LA
363LF0000X
Family Nurse Practitioner
020173
LA
363LF0000X
Family Nurse Practitioner
03124
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2117629
—
LA
Enumeration date
07/14/2010
Last updated
12/23/2011
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