Healthcare Provider Details

I. General information

NPI: 1265911523
Provider Name (Legal Business Name): MANDY LYNNE BARKER NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 SAINT JOHN ST
MONROE LA
71201-8435
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 318-966-8666
  • Fax: 318-966-8667
Mailing address:
  • Phone: 318-966-8666
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP10148
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP10148
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: