Healthcare Provider Details

I. General information

NPI: 1942965751
Provider Name (Legal Business Name): VIRGINIA HOUSTON GANDY APRN, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VIRGINIA LYNN GANDY

II. Dates (important events)

Enumeration Date: 11/05/2021
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
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: 318-322-2140
  • Fax: 318-807-0809
Mailing address:
  • Phone: 318-322-2140
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number214149
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: