SOUTHEAST REHAB LLC. NPI 1295276970

NPI Information

  • NPI: 1295276970
  • Provider Name: SOUTHEAST REHAB LLC.
  • Classification: Nurse Practitioner - 363LG0600X
  • Specialization: Gerontology
  • Entity Type: Organization
  • Doing Business As: SOUTHEAST PART B PRACTICE
  • Address: 903 BORGOGNONI DR
    LAKE VILLAGE, AR
    ZIP 71653
  • Phone: (318) 665-9950

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NPI Details

SOUTHEAST REHAB LLC. is a gerontology nurse practitioner in Lake Village, AR. SOUTHEAST REHAB LLC. NPI is 1295276970. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Southeast Part B Practice.

The provider's business location address is:

903 BORGOGNONI DR
LAKE VILLAGE, AR
ZIP 71653-623
Phone: (318) 665-9950

The provider's authorized official is Cathy Waldrop .
The authorized official title is Administrator and has the following contact phone number (318) 665-9950.

The enumeration date for this NPI number is 3/15/2017 and was last updated on 6/28/2019.

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:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LG0600XNurse PractitionerGerontologyYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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