Healthcare Provider Details

I. General information

NPI: 1699803361
Provider Name (Legal Business Name): THERESE ANN NOVAK N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 OAK PARK BLVD FL 2
LAKE CHARLES LA
70601-8990
US

IV. Provider business mailing address

PO BOX 122108 DEPT 2108
DALLAS TX
75312-0001
US

V. Phone/Fax

Practice location:
  • Phone: 337-494-4900
  • Fax: 337-494-4707
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 NumberAP02313
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: