Healthcare Provider Details

I. General information

NPI: 1629769252
Provider Name (Legal Business Name): TAYLOR R GOUDEAU CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10410 PLANK RD
CLINTON LA
70722-3710
US

IV. Provider business mailing address

4311 DELEE LN
ETHEL LA
70730-3226
US

V. Phone/Fax

Practice location:
  • Phone: 225-683-8877
  • Fax: 225-683-1349
Mailing address:
  • Phone: 225-719-6353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number232377
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: