Healthcare Provider Details

I. General information

NPI: 1053231522
Provider Name (Legal Business Name): AMBER DECELLE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31396 PEA RIDGE RD
ALBANY LA
70711-2702
US

IV. Provider business mailing address

31396 PEA RIDGE RD
ALBANY LA
70711-2702
US

V. Phone/Fax

Practice location:
  • Phone: 985-215-9253
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number248203
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: