Healthcare Provider Details

I. General information

NPI: 1366359440
Provider Name (Legal Business Name): MICHELLE CHANEY CHAMPAGNE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11872 WILDWOOD LN
CLINTON LA
70722-4247
US

IV. Provider business mailing address

11872 WILDWOOD LN
CLINTON LA
70722-4247
US

V. Phone/Fax

Practice location:
  • Phone: 225-461-7653
  • Fax: 225-282-1199
Mailing address:
  • Phone: 225-461-7653
  • Fax: 225-282-1199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number661432
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: