Organization
PEACOCK PRIMARY CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BRANDY PEACOCK MSN, APRN, FNP-BS (OWNER)
(318) 510-3943
Entity
Organization
Contact information
Practice address
426 GOLDSBERRY CIR, SHREVEPORT, LA 71106-8346
(318) 510-3943
(888) 366-9528
Mailing address
426 GOLDSBERRY CIR, SHREVEPORT, LA 71106-8346
(318) 510-3943
(888) 366-9528
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1810843
—
LA
Enumeration date
01/08/2024
Last updated
01/08/2024
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