Individual
MS. LISA COX REARDON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.ED
Contact information
Practice address
307 NORTH CASTLEMAN STREET, OAK GROVE, LA 71263-0788
(318) 428-3249
(318) 428-7547
Mailing address
PO BOX 761, 1627 SKINNER LANE, OAK GROVE, LA 71263-0761
(318) 428-3249
(318) 428-7547
Taxonomy
Speciality
Code
Description
License number
State
376G00000X
Nursing Home Administrator
Primary
1183
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1511595
—
LA
Enumeration date
06/15/2006
Last updated
07/08/2007
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