Healthcare Provider Details

I. General information

NPI: 1972120665
Provider Name (Legal Business Name): CHELSEA LYNNE MCGEE WALLEY WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 CORPORATE BLVD
LAFAYETTE LA
70508-3850
US

IV. Provider business mailing address

105 CORPORATE BLVD
LAFAYETTE LA
70508-3850
US

V. Phone/Fax

Practice location:
  • Phone: 337-593-9099
  • Fax:
Mailing address:
  • Phone: 337-593-9099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number221879
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: