Healthcare Provider Details

I. General information

NPI: 1750946000
Provider Name (Legal Business Name): STORMY DOOLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8706 JEFFERSON HWY STE A
BATON ROUGE LA
70809-2233
US

IV. Provider business mailing address

30826 LINDER RD
DENHAM SPRINGS LA
70726-8507
US

V. Phone/Fax

Practice location:
  • Phone: 225-926-9706
  • Fax:
Mailing address:
  • Phone: 225-665-7878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: