Provider Demographics
NPI:1649516261
Name:PRACTICARE, LLC
Entity type:Organization
Organization Name:PRACTICARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:DUCOTE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:318-739-0086
Mailing Address - Street 1:597 TUNICA DRIVE W
Mailing Address - Street 2:
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351
Mailing Address - Country:US
Mailing Address - Phone:318-253-0866
Mailing Address - Fax:318-253-0864
Practice Address - Street 1:7406 HIGHWAY 1 STE 103
Practice Address - Street 2:
Practice Address - City:MANSURA
Practice Address - State:LA
Practice Address - Zip Code:71350-4230
Practice Address - Country:US
Practice Address - Phone:318-739-0086
Practice Address - Fax:877-325-2708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-31
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2327950Medicaid