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Organization
PSYCHIATRIC NURSE PRACTITIONERS
Active
Organization
PSYCHIATRIC NURSE PRACTITIONERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENISE KNIGHT (CREDENTIALING ADMIN)
(845) 551-9673
Entity
Organization
Contact information
Practice address
1651 E 70TH ST # 382, SHREVEPORT, LA 71105-5115
(318) 560-5883
(318) 216-3940
Mailing address
2208 KIBER ST, SHREVEPORT, LA 71104-2045
(318) 560-5883
(318) 617-1590
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN79944 AP3962
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1032026
—
LA
01
—
210016
PRESCRIPTIVE AUTHORITY (PA)
LA
01
—
30188717
ANCC CREDENTIALING
—
01
—
35169
CDS
LA
01
—
3962
ADVANCE PRACTICE (AP) LICENSE
LA
01
—
79944
RN LICENSE NO.
LA
Enumeration date
02/17/2015
Last updated
03/07/2023
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