Individual
DOUGLAS COUNCIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNPC
Contact information
Practice address
335 MAIN ST, MARION, LA 71260-5253
(318) 283-8887
Mailing address
PO BOX 792, BASTROP, LA 71221-0792
(318) 283-8887
(318) 281-6339
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
AP03480
LA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP03480
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1561479
—
LA
Enumeration date
07/03/2006
Last updated
01/09/2020
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