Healthcare Provider Details

I. General information

NPI: 1245240951
Provider Name (Legal Business Name): DAPHNE ANN GLINDMEYER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 RIVERHIGHLANDS
COVINGTON LA
70433
US

IV. Provider business mailing address

P.O. BOX 4240
COVINGTON LA
70434
US

V. Phone/Fax

Practice location:
  • Phone: 504-392-8348
  • Fax: 504-398-4334
Mailing address:
  • Phone: 504-392-8348
  • Fax: 504-398-4334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number10559R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number10559R
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD.10559R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: