Provider Demographics
NPI:1053146779
Name:SUMMERSGILL, CAROLINE BURT
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:BURT
Last Name:SUMMERSGILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 QUAIL LN
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-2868
Mailing Address - Country:US
Mailing Address - Phone:318-514-9352
Mailing Address - Fax:
Practice Address - Street 1:1606 QUAIL LN
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-2868
Practice Address - Country:US
Practice Address - Phone:318-514-9352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant