Provider Demographics
NPI:1780175000
Name:SAMPRATT, ALEX IV
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:SAMPRATT
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5623 NAVAHO TRL
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-2853
Mailing Address - Country:US
Mailing Address - Phone:318-206-7960
Mailing Address - Fax:
Practice Address - Street 1:5623 NAVAHO TRL
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-2853
Practice Address - Country:US
Practice Address - Phone:318-206-7960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator