MEDICARE: MRS. KATIE DOMINGUE DOGGETT 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	231545	LA

General Provider Information

NPI Number	:	1821776907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATIE DOMINGUE DOGGETT FNP-C

Provider Business Mailing Address
First Line	:	5959 S SHERWOOD FOREST BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-6038
Country	:	US
Telephone Number	:	337-470-7849
Fax Number	:	225-765-9196

Provider Business Practice Location Address
First Line	:	127 ACORN DR STE B
Second Line	:
City	:	SUNSET
State	:	LA
Zip	:	70584-6134
Country	:	US
Telephone Number	:	337-470-7849
Fax Number	:

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

Provider Enumeration Date	:	07/07/2023
Last Update Date	:	05/03/2024

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