Organization
PHOENIX PROVIDER SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE HOWARD (MANAGER)
(337) 991-9276
Entity
Organization
Contact information
Practice address
1509 DULLES DR, LAFAYETTE, LA 70506-3718
(337) 991-9276
(337) 991-9288
Mailing address
1509 DULLES DR, LAFAYETTE, LA 70506-3718
(337) 991-9276
(337) 991-9288
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/20/2015
Last updated
11/05/2015
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