Provider Demographics
NPI:1437551090
Name:AVOYELLES WOMEN'S HEALTHCARE, LLC
Entity Type:Organization
Organization Name:AVOYELLES WOMEN'S HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WHNP
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:RACHAL
Authorized Official - Suffix:
Authorized Official - Credentials:WHNP
Authorized Official - Phone:318-876-2800
Mailing Address - Street 1:1408 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:COTTONPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71327-3514
Mailing Address - Country:US
Mailing Address - Phone:318-876-2800
Mailing Address - Fax:
Practice Address - Street 1:1408 FRONT ST
Practice Address - Street 2:
Practice Address - City:COTTONPORT
Practice Address - State:LA
Practice Address - Zip Code:71327-3514
Practice Address - Country:US
Practice Address - Phone:318-876-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06238302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAP06238OtherADVANCE PRACTICE NURSE
LA1386959351OtherNPI
LA2125419Medicaid