Healthcare Provider Details

I. General information

NPI: 1346323235
Provider Name (Legal Business Name): DEBRALEE ANN POPULIS APRN-BC, MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31330 HIGHWAY 22 STE 101
SPRINGFIELD LA
70462-7427
US

IV. Provider business mailing address

31330 HIGHWAY 22 STE 101
SPRINGFIELD LA
70462-7427
US

V. Phone/Fax

Practice location:
  • Phone: 225-414-0690
  • Fax: 225-414-0693
Mailing address:
  • Phone: 225-414-0690
  • Fax: 225-414-0693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPO4906
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN101773
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: