Healthcare Provider Details

I. General information

NPI: 1144687765
Provider Name (Legal Business Name): MRS. NICOLE MICHELE WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58155 CHINN ST STE B
PLAQUEMINE LA
70764-3601
US

IV. Provider business mailing address

2003 SILVERSTONE AVE STE B
PORT ALLEN LA
70767-3320
US

V. Phone/Fax

Practice location:
  • Phone: 225-385-4543
  • Fax:
Mailing address:
  • Phone: 225-439-5056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number15694
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: