Provider Demographics
NPI:1003402876
Name:DSD HEALTH SERVICES
Entity Type:Organization
Organization Name:DSD HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHRIEKA
Authorized Official - Middle Name:TAREASE
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:318-243-0436
Mailing Address - Street 1:2505 CYPRESS SPRINGS AVE
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-5109
Mailing Address - Country:US
Mailing Address - Phone:318-243-0436
Mailing Address - Fax:
Practice Address - Street 1:210 HIGHWAY 167 N
Practice Address - Street 2:
Practice Address - City:BERNICE
Practice Address - State:LA
Practice Address - Zip Code:71222-5117
Practice Address - Country:US
Practice Address - Phone:318-243-0436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-16
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty