Provider Demographics
NPI:1033646781
Name:SISTERS MEDICAL CLINIC LLC
Entity Type:Organization
Organization Name:SISTERS MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:318-729-2411
Mailing Address - Street 1:239 CATO RD
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71295-5813
Mailing Address - Country:US
Mailing Address - Phone:318-729-2411
Mailing Address - Fax:
Practice Address - Street 1:1205 HWY 15
Practice Address - Street 2:
Practice Address - City:BASKIN
Practice Address - State:LA
Practice Address - Zip Code:71219
Practice Address - Country:US
Practice Address - Phone:318-248-2249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06744363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty