Healthcare Provider Details

I. General information

NPI: 1710898473
Provider Name (Legal Business Name): BRITTANY NICOLE PAULK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 GLENMAR AVE
MONROE LA
71201-5309
US

IV. Provider business mailing address

1102 FLANAGAN RD LOT 8
WEST MONROE LA
71291-9171
US

V. Phone/Fax

Practice location:
  • Phone: 318-327-8223
  • Fax:
Mailing address:
  • Phone: 318-680-9740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number203399
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: