Provider Demographics
NPI:1578039921
Name:RED STICK HEALTHCARE
Entity type:Organization
Organization Name:RED STICK HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRBY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HUMBLES
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:225-931-3532
Mailing Address - Street 1:16733 WENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-6957
Mailing Address - Country:US
Mailing Address - Phone:225-931-3532
Mailing Address - Fax:
Practice Address - Street 1:16733 WENWOOD DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-6957
Practice Address - Country:US
Practice Address - Phone:225-931-3532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty