Healthcare Provider Details

I. General information

NPI: 1760175533
Provider Name (Legal Business Name): ELIZABETH JEANINE RIDDLE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 JACKSON ST
MONROE LA
71201-7407
US

IV. Provider business mailing address

610 MATTHEW ST
MONROE LA
71201-2752
US

V. Phone/Fax

Practice location:
  • Phone: 318-966-4595
  • Fax: 318-966-5295
Mailing address:
  • Phone: 318-557-3555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number241547
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN119497
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61223549
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: