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Individual

TRACIE ROUSSEL O'BANNON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
735 HIGHWAY 30 STE D, SAINT GABRIEL, LA 70776-5015
(225) 314-9314
Mailing address
39041 BALMORAL DR, PRAIRIEVILLE, LA 70769-4854

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
245084
LA

Other

Enumeration date
01/07/2026
Last updated
04/07/2026
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