Healthcare Provider Details

I. General information

NPI: 1821764440
Provider Name (Legal Business Name): DANIELLE LEIGH GULLETTE APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 CALYPSO ST STE 210
MONROE LA
71201-7551
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 318-966-6500
  • Fax: 328-966-6501
Mailing address:
  • Phone: 225-765-5727
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number220799
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: