Provider Demographics
NPI:1952519639
Name:ROSALES CHILDREN'S CLINIC
Entity Type:Organization
Organization Name:ROSALES CHILDREN'S CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLI
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHOWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-338-3585
Mailing Address - Street 1:104 CONTEMPO AVE
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5312
Mailing Address - Country:US
Mailing Address - Phone:318-807-1360
Mailing Address - Fax:318-807-1364
Practice Address - Street 1:104 CONTEMPO AVE
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7366
Practice Address - Country:US
Practice Address - Phone:318-338-3585
Practice Address - Fax:318-338-3588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN070425 AP03721363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty