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General NPI Number Information
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NPI Number | 1588040703
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Entity Type | Individual
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Provider Name | EMILY WILLARD NP
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Gender | Female
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Dates
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Enumeration Date | 08/11/2015
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 107 FRONT ST STE 2126
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City | VIDALIA
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State | LA
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Zip | 71373-2835
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Country | US
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Telephone | 318-414-9336
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Fax | 318-599-1178
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Provider Business Mailing Address
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Address Line | 604 N ACADIA RD STE 101
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City | THIBODAUX
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State | LA
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Zip | 70301-4897
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Country | US
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Telephone | 985-446-5079
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Fax | 985-447-2497
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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 | AP08458
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License Number State | LA
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