Individual
PHYLLIS CAUDILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1860 FAIRFIELD AVE, SHREVEPORT, LA 71101-4431
(318) 642-9450
Mailing address
1860 FAIRFIELD AVE, SHREVEPORT, LA 71101-4431
(318) 642-9450
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
906229
MS
Other
Enumeration date
12/04/2023
Last updated
12/04/2023
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