Healthcare Provider Details

I. General information

NPI: 1164430526
Provider Name (Legal Business Name): ROSALINE MICHELLE DARTY AP NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROSALINE MICHELLE CALDWELL AP NP

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 DAVID RAINES RD
SHREVEPORT LA
71107-5899
US

IV. Provider business mailing address

2508 BERT KOUNS INDUSTRIAL LOOP
SHREVEPORT LA
71118-3133
US

V. Phone/Fax

Practice location:
  • Phone: 318-425-2252
  • Fax: 318-425-2367
Mailing address:
  • Phone: 318-212-5880
  • Fax: 318-212-5885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberAP04803
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN088507-AP04803
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP04803
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: