Individual
JOHN CHARLES CHARITY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-BC
Contact information
Practice address
503 BROADMOOR BLVD, SHREVEPORT, LA 71105-2023
(318) 868-7537
(318) 868-7537
Mailing address
503 BROADMOOR BLVD, SHREVEPORT, LA 71105-2023
(318) 868-7537
(318) 868-7537
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN071365
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1545201
—
LA
Enumeration date
07/19/2006
Last updated
09/20/2013
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