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General NPI Number Information
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NPI Number | 1164649927
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Entity Type | Individual
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Provider Name | DIANE RENEE MCCULLER NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 7925 YOUREE DR SUITE 280A
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City | SHREVEPORT
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State | LA
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Zip | 71105-5538
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Country | US
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Telephone | 318-798-6833
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Fax | 318-798-6835
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Provider Business Mailing Address
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Address Line | 7925 YOUREE DR SUITE 280A
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City | SHREVEPORT
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State | LA
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Zip | 71105-5538
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Country | US
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Telephone | 318-798-6833
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Fax | 318-798-6835
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN051830
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APL-APO 1867
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License Number State | LA
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