Healthcare Provider Details

I. General information

NPI: 1194334433
Provider Name (Legal Business Name): JULIE E THORN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19503 LAKE CHARLES HWY STE B
DERIDDER LA
70634-2322
US

IV. Provider business mailing address

19503 LAKE CHARLES HWY STE B
DERIDDER LA
70634-2322
US

V. Phone/Fax

Practice location:
  • Phone: 337-221-0337
  • Fax: 337-221-0367
Mailing address:
  • Phone: 337-221-0337
  • Fax: 337-221-0367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number213743
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: