NPIMap

Organization Active NPI

Desoto Healthcare Center Inc.

  • Family Medicine Physician
  • Mansfield, LA
National Provider Identifier
1811209232
Registry record updated Dec 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD199935 Issued in LA
Legal business name
DESOTO HEALTHCARE CENTER INC.
Practice address
938 Louise St
Mansfield, LA 71052
Phone
(318) 871-1633
Fax
(318) 871-1677
NPI assigned
Jul 14, 2010
Last updated
Dec 23, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Connie B Gannon, FNP
Title
Family Nurse Practitioner
Phone
(318) 871-1633

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X MD199935 LA Primary
Nephrology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RN0300X 1487481 LA
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X 1996971 LA
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X 03124 LA
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X 020173 LA

Addresses

Primary practice location

938 Louise St
Mansfield, LA 71052

Mailing address

PO Box 1384
Mansfield, LA 71052-1384
Phone (318) 871-1633

National Provider Directory

National Provider Directory

Locations

7356 Highway 509
Mansfield, LA 71052
Phone (318) 871-1633

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1279065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324598400000",
    "number": "1811209232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1384",
            "city": "MANSFIELD",
            "state": "LA",
            "postal_code": "710521384",
            "telephone_number": "318-871-1633",
            "fax_number": "318-871-1677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "938 LOUISE ST",
            "city": "MANSFIELD",
            "state": "LA",
            "postal_code": "71052",
            "telephone_number": "318-871-1633",
            "fax_number": "318-871-1677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESOTO HEALTHCARE CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-14",
        "last_updated": "2011-12-23",
        "status": "A",
        "authorized_official_last_name": "GANNON",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "FAMILY NURSE PRACTITIONER",
        "authorized_official_telephone_number": "318-871-1633",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "MD199935",
            "primary": true
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "LA",
            "license": "1487481",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "1996971",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "03124",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "020173",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mansfield, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.