Individual
DANIELLE JACKSON THREATTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
105 INDEPENDENCE BLVD STE 1, LAFAYETTE, LA 70506-8710
(337) 534-4087
Mailing address
405 N PARKERSON ST, RAYNE, LA 70578-6544
(337) 534-4087
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP07019
LA
Other
Enumeration date
07/31/2012
Last updated
05/01/2020
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