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NPI Code Detail

MEDICARE: THELEISHA NELSON ANTOINE

MEDICARE: THELEISHA NELSON ANTOINE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner245748LA

General Provider Information

NPI Number : 1164378469
Entity Type Code : Individual
Provider Name (Legal Business Name) : THELEISHA NELSON ANTOINE
Provider Business Mailing Address
First Line : 104 HERSHEY CT
Second Line :
City : BROUSSARD
State : LA
Zip : 70518-5157
Country : US
Telephone Number : 337-255-4445
Fax Number :
Provider Business Practice Location Address
First Line : 104 HERSHEY CT
Second Line :
City : BROUSSARD
State : LA
Zip : 70518-5157
Country : US
Telephone Number : 337-255-4445
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2026
Last Update Date : 03/26/2026

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Directions to “ THELEISHA NELSON ANTOINE ” Practice Location

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