Individual
MS. PERRY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1520 HIGHWAY 22 W, MADISONVILLE, LA 70447
(985) 773-1600
Mailing address
1520 HIGHWAY 22 W, MADISONVILLE, LA 70447-9441
(985) 773-1600
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP07653
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2381199
—
LA
Enumeration date
01/28/2014
Last updated
06/05/2019
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