Provider Demographics
NPI:1316230394
Name:MENOPAUSE & HORMONE SPECIALTY CENTER, LLC
Entity type:Organization
Organization Name:MENOPAUSE & HORMONE SPECIALTY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMI
Authorized Official - Middle Name:K
Authorized Official - Last Name:HERKEY
Authorized Official - Suffix:
Authorized Official - Credentials:WHNP
Authorized Official - Phone:318-288-1327
Mailing Address - Street 1:7591 FERN AVE
Mailing Address - Street 2:SUITE #1501
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5750
Mailing Address - Country:US
Mailing Address - Phone:318-524-8032
Mailing Address - Fax:318-524-8033
Practice Address - Street 1:7591 FERN AVE
Practice Address - Street 2:SUITE #1501
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5750
Practice Address - Country:US
Practice Address - Phone:318-524-8032
Practice Address - Fax:318-524-8033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03544363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1567183Medicaid
LA5DU26Medicare PIN