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General NPI Number Information
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NPI Number | 1043601685
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Entity Type | Organization
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Legal Business Name | PSYCHIATRIC NURSE PRACTITIONERS
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Dates
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Enumeration Date | 02/17/2015
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1651 E 70TH ST # 382
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City | SHREVEPORT
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State | LA
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Zip | 71105-5115
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Country | US
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Telephone | 318-560-5883
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Fax | 318-216-3940
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Provider Business Mailing Address
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Address Line | 2208 KIBER ST
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City | SHREVEPORT
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State | LA
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Zip | 71104-2045
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Country | US
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Telephone | 318-560-5883
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Fax | 318-617-1590
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Authorized Official
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Title or Position | CREDENTIALING ADMIN
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Name | DENISE KNIGHT
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Credential |
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Telephone | 845-551-9673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN79944 AP3962
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License Number State | LA
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