Healthcare Provider Details

I. General information

NPI: 1942134531
Provider Name (Legal Business Name): SAMUEL C WHITAKER MSN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2449 HOSPITAL DR STE 200
BOSSIER CITY LA
71111-1905
US

IV. Provider business mailing address

2449 HOSPITAL DR STE 200
BOSSIER CITY LA
71111-1905
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-7841
  • Fax: 318-212-7846
Mailing address:
  • Phone: 318-212-7841
  • Fax: 318-212-7846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number248139
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: