MEDICARE: KATIE MANALE APRN, FNP-C

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
1	363LF0000X	Family Nurse Practitioner	234718	LA

General Provider Information

NPI Number	:	1770343238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE MANALE APRN, FNP-C

Provider Business Mailing Address
First Line	:	276 FAYEDAYE DR
Second Line	:
City	:	MADISONVILLE
State	:	LA
Zip	:	70447-3177
Country	:	US
Telephone Number	:	985-290-0366
Fax Number	:

Provider Business Practice Location Address
First Line	:	7307 E OLD SPANISH TRL
Second Line	:
City	:	JEANERETTE
State	:	LA
Zip	:	70544-6100
Country	:	US
Telephone Number	:	877-878-3289
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2024
Last Update Date	:	03/21/2024

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