Healthcare Provider Details

I. General information

NPI: 1093189185
Provider Name (Legal Business Name): LINDA GILBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2015
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4306 S GRAND ST
MONROE LA
71202-6322
US

IV. Provider business mailing address

1000 CHINABERRY DR STE 900
BOSSIER CITY LA
71111-2455
US

V. Phone/Fax

Practice location:
  • Phone: 318-324-5441
  • Fax: 318-324-5442
Mailing address:
  • Phone: 318-324-5441
  • Fax: 318-324-5442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number5424
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: