Provider Demographics
NPI:1497034565
Name:DOUGHTY, TESSIE LACROIX (NP)
Entity Type:Individual
Prefix:MRS
First Name:TESSIE
Middle Name:LACROIX
Last Name:DOUGHTY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 MEDICAL CENTER DR
Mailing Address - Street 2:BOX 30140
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-8124
Mailing Address - Country:US
Mailing Address - Phone:318-487-1358
Mailing Address - Fax:318-487-9584
Practice Address - Street 1:501 MEDICAL CENTER DR
Practice Address - Street 2:BOX 30140
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8124
Practice Address - Country:US
Practice Address - Phone:318-487-1358
Practice Address - Fax:318-487-9584
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN119064-AP06621363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics