Basic Information
| Provider Information | |||||||||
| NPI: | 1093488348 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEADFAST HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 134 HOMERUN PKWY | ||||||||
| Address2: | |||||||||
| City: | DONALDSONVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703468458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5046104436 | ||||||||
| FaxNumber: | 2252091423 | ||||||||
| Practice Location | |||||||||
| Address1: | 17188 AIRLINE HWY STE M#538 | ||||||||
| Address2: | |||||||||
| City: | PRAIRIEVILLE | ||||||||
| State: | LOUISIANA | ||||||||
| PostalCode: | 70769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257251511 | ||||||||
| FaxNumber: | 2252091423 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2021 | ||||||||
| LastUpdateDate: | 10/28/2022 | ||||||||
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| AuthorizedOfficialLastName: | DIXSON | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 5046104436 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | NURSE PRACTITIONER | ||||||||
| NPICertificationDate: | 07/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.