Healthcare Provider Details

I. General information

NPI: 1881226561
Provider Name (Legal Business Name): ELENA URBIZTONDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELENA URBIZTONDO PMHNP-BC

II. Dates (important events)

Enumeration Date: 02/10/2020
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2924 KNIGHT ST STE 402
SHREVEPORT LA
71105-2413
US

IV. Provider business mailing address

9832 AMBLEWOOD LN
SHREVEPORT LA
71118-5054
US

V. Phone/Fax

Practice location:
  • Phone: 318-408-2880
  • Fax:
Mailing address:
  • Phone: 318-671-3088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number211603
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: