Provider Demographics
NPI:1245588300
Name:SEASONS PRIMARY CARE
Entity Type:Organization
Organization Name:SEASONS PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-255-7591
Mailing Address - Street 1:1809 NORTHPOINTE LN
Mailing Address - Street 2:SUITE 203
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-3853
Mailing Address - Country:US
Mailing Address - Phone:318-255-7591
Mailing Address - Fax:318-255-7584
Practice Address - Street 1:1809 NORTHPOINTE LN
Practice Address - Street 2:SUITE 203
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-3853
Practice Address - Country:US
Practice Address - Phone:318-255-7591
Practice Address - Fax:318-255-7584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06950364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA094105OtherRN
LAAP06950OtherNURSE PRACTITIONER