Individual
DR. STACY D CONVILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
902 S VIENNA ST, RUSTON, LA 71270-5830
(318) 551-4311
(318) 551-4355
Mailing address
902 S VIENNA ST, RUSTON, LA 71270-5830
(318) 551-4355
(318) 551-4335
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
026106
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1052931
—
LA
Enumeration date
05/30/2006
Last updated
03/02/2026
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