Provider Demographics
NPI:1831853076
Name:ALLIGOOD, FLAVIUS LEROY II (NURSE CASE MANAGER)
Entity type:Individual
Prefix:MR
First Name:FLAVIUS
Middle Name:LEROY
Last Name:ALLIGOOD
Suffix:II
Gender:M
Credentials:NURSE CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 CARLIN RD
Mailing Address - Street 2:
Mailing Address - City:ANACOCO
Mailing Address - State:LA
Mailing Address - Zip Code:71403-3248
Mailing Address - Country:US
Mailing Address - Phone:337-424-0153
Mailing Address - Fax:
Practice Address - Street 1:1585 3RD ST BLDG 285
Practice Address - Street 2:
Practice Address - City:FORT POLK
Practice Address - State:LA
Practice Address - Zip Code:71459-5102
Practice Address - Country:US
Practice Address - Phone:337-531-2889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA089476163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management