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Organization

PELICAN PEDIATRICS, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. LESLIE COUVILLON BRASHER APRN, CPNP (OWNER, MANAGER)
(318) 927-3255
Entity
Organization

Contact information

Practice address
911 W MAIN ST, SUITE C, HOMER, LA 71040-3300
(318) 927-3255
(318) 927-3257
Mailing address
911 W MAIN ST, SUITE C, HOMER, LA 71040-3300
(318) 927-3255
(318) 927-3257

Taxonomy

Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
2203781980
LA
363LP0200X
Pediatric Nurse Practitioner
APO5536
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1325295
LA
Enumeration date
11/07/2013
Last updated
10/01/2014
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