Provider Demographics
NPI:1578842027
Name:GRIFFING, PAULA (PNP)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:GRIFFING
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 LOOP RD STE C
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71295-3341
Mailing Address - Country:US
Mailing Address - Phone:318-435-6363
Mailing Address - Fax:318-435-4646
Practice Address - Street 1:2104 LOOP RD STE C
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-3341
Practice Address - Country:US
Practice Address - Phone:318-435-6363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN114177-AP06632363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2162853Medicaid
LAAP06632OtherLICENSE
12391740OtherCAQH
LAAP06632OtherLICENSE