DIVINITY HEALTHCARE CLINIC NPI 1326676792

NPI Information

DIVINITY HEALTHCARE CLINIC is a family nurse practitioner in Baton Rouge, LA. DIVINITY HEALTHCARE CLINIC NPI is 1326676792. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4021 WE HECK CT STE B1
BATON ROUGE, LA
ZIP 70816-405
Phone: (225) 256-7945
Fax: (225) 351-8910

The provider's authorized official is Dawn Melancon .
The authorized official title is Family Nurse Practitioner and has the following contact phone number (225) 301-2982.

The CLIA number assigned to this NPI record is 19D2182938 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/31/2020 and was last updated on 5/5/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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