# DESOTO HEALTHCARE CENTER INC.

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

## Provider details

- **NPI number:** 1811209232
- **Authorized official:** MS. CONNIE B GANNON FNP (FAMILY NURSE PRACTITIONER)
- **Authorized official phone:** (318) 871-1633

## Contact information

- **Practice address:** 938 LOUISE ST, MANSFIELD, LA 71052
- **Practice address phone:** (318) 871-1633
- **Practice address fax:** (318) 871-1677
- **Mailing address:** PO BOX 1384, MANSFIELD, LA 71052-1384
- **Mailing address phone:** (318) 871-1633
- **Mailing address fax:** (318) 871-1677

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | MD199935 | LA | Yes |
| 207RN0300X | Nephrology Physician | 1487481 | LA | — |
| 208000000X | Pediatrics Physician | 1996971 | LA | — |
| 363LF0000X | Family Nurse Practitioner | 020173 | LA | — |
| 363LF0000X | Family Nurse Practitioner | 03124 | LA | — |

## Other

- **Enumeration date:** 07/14/2010
- **Last updated:** 12/23/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2117629 | — | LA |