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General NPI Number Information
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NPI Number | 1841942182
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Entity Type | Individual
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Provider Name | MIKKESHIA GREMILLION FNP-C, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/18/2022
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 8595 PICARDY AVE STE 100
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City | BATON ROUGE
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State | LA
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Zip | 70809-3674
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Country | US
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Telephone | 225-716-2221
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Fax |
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Provider Business Mailing Address
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Address Line | 4059 LASSEN DR
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City | BATON ROUGE
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State | LA
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Zip | 70814-5125
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Country | US
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Telephone | 225-716-2221
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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 | 223858
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1141246
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License Number State | TX
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