Healthcare Provider Details

I. General information

NPI: 1083349435
Provider Name (Legal Business Name): ANGIE EWALT DUKES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 1ST AVE
SULPHUR LA
70663-3424
US

IV. Provider business mailing address

921 1ST AVE
SULPHUR LA
70663-3424
US

V. Phone/Fax

Practice location:
  • Phone: 337-527-6385
  • Fax: 337-527-3527
Mailing address:
  • Phone: 337-287-8285
  • Fax: 337-527-3527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number226551
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: