Healthcare Provider Details

I. General information

NPI: 1801550520
Provider Name (Legal Business Name): NICOLE MEREDITH GARDEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 E MCNEESE ST STE 1
LAKE CHARLES LA
70607-4784
US

IV. Provider business mailing address

1530 E MCNEESE ST STE 1
LAKE CHARLES LA
70607-4784
US

V. Phone/Fax

Practice location:
  • Phone: 337-564-5322
  • Fax:
Mailing address:
  • Phone: 337-564-5322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number232435
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: