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General NPI Number Information
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NPI Number | 1205124310
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Entity Type | Individual
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Provider Name | LETARSHA ROULETTE CAMPBELL FNP
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Gender | Female
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Dates
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Enumeration Date | 07/11/2011
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Last Update Date | 05/07/2021
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Provider Practice Location Address
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Address Line | 11990 JACKSON ST
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City | CLINTON
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State | LA
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Zip | 70722-3210
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Country | US
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Telephone | 225-683-5292
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Fax | 225-683-1310
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Provider Business Mailing Address
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Address Line | 80 EDWARD WELLS LN
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City | GREENSBURG
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State | LA
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Zip | 70441-4081
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Country | US
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Telephone | 225-405-5277
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APO6289
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP06289
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License Number State | LA
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