Healthcare Provider Details

I. General information

NPI: 1093462376
Provider Name (Legal Business Name): EMILIE ANNE ADEKANBI FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 WOLF CIR
LAKE CHARLES LA
70605-2353
US

IV. Provider business mailing address

PO BOX 122525 DEPT 2525
DALLAS TX
75312-2152
US

V. Phone/Fax

Practice location:
  • Phone: 337-480-7499
  • Fax: 337-480-7498
Mailing address:
  • Phone: 337-494-2921
  • Fax: 337-494-6523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number224420
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: