Provider Demographics
NPI:1003874314
Name:YEMBE, ENAKA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ENAKA
Middle Name:MARIE
Last Name:YEMBE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIE SUSAN
Other - Middle Name:
Other - Last Name:ENAKA YEMBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 445
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71273-0445
Mailing Address - Country:US
Mailing Address - Phone:318-436-2600
Mailing Address - Fax:318-436-2601
Practice Address - Street 1:612 S. FARMERVILLE STREET
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270
Practice Address - Country:US
Practice Address - Phone:318-436-2600
Practice Address - Fax:318-436-2601
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ5954207Q00000X
LA199975207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1054453Medicaid
LA1054453Medicaid
LA1054453Medicaid