Individual
PHILLIP M PRIDDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 675-5584
Mailing address
1501 KINGS HWY, SHREVEPORT, LA 71130-4228
(318) 675-5584
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN054704
LA
Other
Enumeration date
10/17/2006
Last updated
04/23/2015
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