Healthcare Provider Details

I. General information

NPI: 1265367544
Provider Name (Legal Business Name): SYDNI RAE CALLAHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 W FERTITTA BLVD
LEESVILLE LA
71446-4645
US

IV. Provider business mailing address

1855 HIGHWAY 27
DERIDDER LA
70634-5477
US

V. Phone/Fax

Practice location:
  • Phone: 337-239-9041
  • Fax:
Mailing address:
  • Phone: 337-401-9480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201249
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: