Provider Demographics
NPI:1588080386
Name:PINE PRAIRIE FAMILY HEALTHCARE, LLC
Entity type:Organization
Organization Name:PINE PRAIRIE FAMILY HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUCET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-779-6000
Mailing Address - Street 1:1015 SANDERS STREET
Mailing Address - Street 2:PO BOX 736
Mailing Address - City:PINE PRAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70576-3611
Mailing Address - Country:US
Mailing Address - Phone:337-599-2850
Mailing Address - Fax:337-599-2852
Practice Address - Street 1:1015 SANDERS STREET
Practice Address - Street 2:
Practice Address - City:PINE PRAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70576-3611
Practice Address - Country:US
Practice Address - Phone:337-599-2850
Practice Address - Fax:337-599-2852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center