Provider Demographics
NPI:1639617103
Name:LIL SPROUTS PEDIATRICS & FAMILY CLINIC LLC
Entity Type:Organization
Organization Name:LIL SPROUTS PEDIATRICS & FAMILY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMOSS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:318-512-4112
Mailing Address - Street 1:4624 CYPRESS ST
Mailing Address - Street 2:SUITE 6&7
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-1348
Mailing Address - Country:US
Mailing Address - Phone:318-512-4112
Mailing Address - Fax:318-570-5903
Practice Address - Street 1:4624 CYPRESS ST
Practice Address - Street 2:SUITE 6&7
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-1348
Practice Address - Country:US
Practice Address - Phone:318-512-4112
Practice Address - Fax:318-570-5903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-05
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08400363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty