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Organization

SLAINTE FAMILY CLINIC LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. PAULA WEAVER GATES APRN FNP-C (SOLE OWNER)
(318) 518-8329
Entity
Organization

Contact information

Practice address
188 BURT BLVD, BENTON, LA 71006-4900
(318) 965-1000
Mailing address
121 GATES DR, BENTON, LA 71006-4119
(318) 518-8329

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP07052
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1013264878
NPI
LA
05
2345419
LA
Enumeration date
01/07/2013
Last updated
01/27/2015
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