Healthcare Provider Details

I. General information

NPI: 1033973391
Provider Name (Legal Business Name): ANNA MICHELE WREN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 LINE AVE FL 3
SHREVEPORT LA
71101-3841
US

IV. Provider business mailing address

1111 LINE AVE FL 3
SHREVEPORT LA
71101-3841
US

V. Phone/Fax

Practice location:
  • Phone: 318-716-4610
  • Fax: 318-716-4690
Mailing address:
  • Phone: 318-716-4610
  • Fax: 318-716-4690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number203345
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number203345
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: