Healthcare Provider Details

I. General information

NPI: 1780537415
Provider Name (Legal Business Name): WANDA ELIZABETH MCKEITHEN MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3424 CYPRESS ST
WEST MONROE LA
71291-7310
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 318-450-4626
  • Fax: 318-600-4078
Mailing address:
  • Phone: 318-450-4626
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number245560
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number245560
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: