Healthcare Provider Details

I. General information

NPI: 1578892956
Provider Name (Legal Business Name): ANNISA TAYLOR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5120 GROOM RD
BAKER LA
70714-3124
US

IV. Provider business mailing address

5120 GROOM RD
BAKER LA
70714-3124
US

V. Phone/Fax

Practice location:
  • Phone: 225-774-1077
  • Fax: 225-774-1078
Mailing address:
  • Phone: 225-774-1077
  • Fax: 225-774-1078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN 05937
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN05937
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: