Healthcare Provider Details

I. General information

NPI: 1013416007
Provider Name (Legal Business Name): DAMETRA DANIELLE TAYLOR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 N ROBINSON ST
MANY LA
71449-3536
US

IV. Provider business mailing address

806 JEFFERSON TER
NEW IBERIA LA
70560-5727
US

V. Phone/Fax

Practice location:
  • Phone: 318-256-8150
  • Fax: 318-256-8136
Mailing address:
  • Phone: 337-365-4945
  • Fax: 337-376-6860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP09786
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: