Provider Demographics
NPI:1134090061
Name:PROVISION HEALTH CARE LLC
Entity type:Organization
Organization Name:PROVISION HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MELOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-322-9252
Mailing Address - Street 1:PO BOX 510
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71294-0510
Mailing Address - Country:US
Mailing Address - Phone:318-322-9252
Mailing Address - Fax:318-322-2885
Practice Address - Street 1:525 W FAULKNER ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4518
Practice Address - Country:US
Practice Address - Phone:870-337-2009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROVISION HEALTH CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty