Provider Demographics
NPI:1003361437
Name:PETERSON, JOYCE
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6391 HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-8757
Mailing Address - Country:US
Mailing Address - Phone:318-929-9000
Mailing Address - Fax:318-929-2000
Practice Address - Street 1:6391 HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-8757
Practice Address - Country:US
Practice Address - Phone:318-929-9000
Practice Address - Fax:318-929-2000
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No376J00000XNursing Service Related ProvidersHomemaker