Healthcare Provider Details

I. General information

NPI: 1982199295
Provider Name (Legal Business Name): RENEE WALES MORGAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 VETERANS AVE
HAMMOND LA
70403-1513
US

IV. Provider business mailing address

41067 DUVIC LN
PONCHATOULA LA
70454-6333
US

V. Phone/Fax

Practice location:
  • Phone: 985-902-7770
  • Fax:
Mailing address:
  • Phone: 985-634-0916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10058
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: