Provider Demographics
NPI:1689116964
Name:FORD, LINDA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1470
Mailing Address - Street 2:
Mailing Address - City:JENA
Mailing Address - State:LA
Mailing Address - Zip Code:71342-1470
Mailing Address - Country:US
Mailing Address - Phone:318-992-4133
Mailing Address - Fax:318-992-4134
Practice Address - Street 1:11809 HIGHWAY 84 W
Practice Address - Street 2:
Practice Address - City:JENA
Practice Address - State:LA
Practice Address - Zip Code:71342-3703
Practice Address - Country:US
Practice Address - Phone:318-992-4133
Practice Address - Fax:318-992-4134
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09074364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health