1336677806 NPI number — CRESHA LOUISE TILLMAN FRANCOIS MHS

Table of content: CRESHA LOUISE TILLMAN FRANCOIS MHS (NPI 1336677806)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336677806 NPI number — CRESHA LOUISE TILLMAN FRANCOIS MHS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TILLMAN FRANCOIS
Provider First Name:
CRESHA
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MHS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TILLMAN FRANCOIS
Provider Other First Name:
CRESHA
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MHS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336677806
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1409 KIRKMAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE CHARLES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70601-5344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-419-3586
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1409 KIRKMAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70601-5344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-802-3914
Provider Business Practice Location Address Fax Number:
337-802-3914
Provider Enumeration Date:
05/30/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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