Basic Information
| Provider Information | |||||||||
| NPI: | 1306479175 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEALTH2YOU | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | HEALTH 2 YOU OF MISS-LOU | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 100B LINCOLN AVE | ||||||||
| Address2: | |||||||||
| City: | FERRIDAY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713342046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252887081 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100B LINCOLN AVE | ||||||||
| Address2: | |||||||||
| City: | FERRIDAY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713342046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252887081 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2020 | ||||||||
| LastUpdateDate: | 06/03/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CAMPBELL-SMITH | ||||||||
| AuthorizedOfficialFirstName: | RAVEN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2252887081 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | NURSE PRACTITIONER | ||||||||
| NPICertificationDate: | 06/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | N | Agencies | Home Health | 261QP2300X | N | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | 363LF0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.