=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659049302
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDSEY OLIVER MISITA FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2021
-----------------------------------------------------
Last Update Date | 09/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 409 NW CENTRAL AVE
-----------------------------------------------------
City | AMITE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-748-7141
-----------------------------------------------------
Fax | 985-748-3181
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 WALNUT ST.
-----------------------------------------------------
City | AMITE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-284-2400
-----------------------------------------------------
Fax | 985-748-8144
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 221568
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------