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General NPI Number Information
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NPI Number | 1619787975
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Entity Type | Individual
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Provider Name | LAKIN DANIELLE BLUE NP
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Gender | Female
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Dates
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Enumeration Date | 01/09/2025
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 242 SAM HOUSTON JONES PKWY
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City | MOSS BLUFF
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State | LA
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Zip | 70611-5603
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Country | US
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Telephone | 337-905-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 242 SAM HOUSTON JONES PKWY
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City | MOSS BLUFF
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State | LA
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Zip | 70611-5603
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Country | US
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Telephone | 337-905-4000
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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 | 237294
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License Number State | LA
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