Healthcare Provider Details

I. General information

NPI: 1417565615
Provider Name (Legal Business Name): BOBBY DARRELL CHELETTE PMHNP-BC AND FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 WHEELIS ST
WEST MONROE LA
71292-3940
US

IV. Provider business mailing address

PO BOX 792
BASTROP LA
71221-0792
US

V. Phone/Fax

Practice location:
  • Phone: 318-556-8455
  • Fax: 318-556-8456
Mailing address:
  • Phone: 318-283-8887
  • Fax: 318-281-2559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number214496
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number214496
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: