Healthcare Provider Details

I. General information

NPI: 1609707231
Provider Name (Legal Business Name): NINA WYNETTE TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2165 S ALBERT ST
LUTCHER LA
70071-5237
US

IV. Provider business mailing address

PO BOX 2276
RESERVE LA
70084-2276
US

V. Phone/Fax

Practice location:
  • Phone: 985-233-6313
  • Fax:
Mailing address:
  • Phone: 985-233-5353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN140452
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: