Healthcare Provider Details

I. General information

NPI: 1821318825
Provider Name (Legal Business Name): LISA THOMPSON VIDEAU FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8144 WALNUT HILL LN
DALLAS TX
75231-4388
US

IV. Provider business mailing address

240 RALEIGH DR
SLIDELL LA
70460-8805
US

V. Phone/Fax

Practice location:
  • Phone: 214-785-2200
  • Fax:
Mailing address:
  • Phone: 504-296-1620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN0077394
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN077394-AP06145
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN3399092
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6145
License Number StateLA
# 5
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP06145
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: