Organization
PARADISE CHILDREN'S CLINIC OF LOUISIANA LLC
Active
Other names
Paradise Children's Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY L MASON (OFFICE MANAGER)
(318) 641-6113
Entity
Organization
Contact information
Practice address
4702 MONROE HWY, BALL, LA 71405-3944
(318) 641-6113
(318) 641-6115
Mailing address
4702 MONROE HWY, BALL, LA 71405-3944
(318) 641-6113
(318) 641-6115
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2351192
—
LA
Enumeration date
11/05/2013
Last updated
11/22/2021
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