Provider Demographics
NPI:1093438004
Name:DOVE FAMILY CLINIC, INC
Entity Type:Organization
Organization Name:DOVE FAMILY CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DARLINDA
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:DOVE
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:318-308-6390
Mailing Address - Street 1:702 WOODWIND DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3889
Mailing Address - Country:US
Mailing Address - Phone:318-308-6390
Mailing Address - Fax:
Practice Address - Street 1:1109 7TH AVENUE
Practice Address - Street 2:
Practice Address - City:GLENMORA
Practice Address - State:LA
Practice Address - Zip Code:71433-7143
Practice Address - Country:US
Practice Address - Phone:318-579-8019
Practice Address - Fax:318-656-3181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-23
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty