Provider Demographics
NPI:1811304074
Name:WAFER-MENDENHALL, EKARA N
Entity type:Individual
Prefix:
First Name:EKARA
Middle Name:N
Last Name:WAFER-MENDENHALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:LA
Mailing Address - Zip Code:71040-3221
Mailing Address - Country:US
Mailing Address - Phone:318-265-4542
Mailing Address - Fax:318-550-4271
Practice Address - Street 1:611 W 2ND ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:LA
Practice Address - Zip Code:71040-3221
Practice Address - Country:US
Practice Address - Phone:318-265-4542
Practice Address - Fax:318-550-4271
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN125342363LF0000X
LAAP07981363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily