Healthcare Provider Details

I. General information

NPI: 1821375932
Provider Name (Legal Business Name): CHEQUAN MICHELLE THOMAS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 CROSSROADS BLVD
BOSSIER CITY LA
71111-4867
US

IV. Provider business mailing address

PO BOX 5860
BOSSIER CITY LA
71171-5860
US

V. Phone/Fax

Practice location:
  • Phone: 469-438-8002
  • Fax:
Mailing address:
  • Phone: 469-438-8002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number236622
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP00659
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: