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General NPI Number Information
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NPI Number | 1356257810
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Entity Type | Organization
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Legal Business Name | OMI WOUND CARE
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Dates
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Enumeration Date | 08/24/2026
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Last Update Date | 08/24/2026
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Provider Practice Location Address
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Address Line | 9579 BONNYDUNE DR
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City | SHREVEPORT
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State | LA
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Zip | 71106-7506
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Country | US
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Telephone | 318-455-7085
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Fax |
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Provider Business Mailing Address
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Address Line | 9579 BONNYDUNE DR
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City | SHREVEPORT
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State | LA
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Zip | 71106-7506
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Country | US
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Telephone | 318-455-7085
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | AMIE MICHELLE WILSOM
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Credential | FNP
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Telephone | 318-455-7085
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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 |
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License Number State |
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