Individual
MICKIE DAVINA WOODALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
113 CHRISTIAN LN, SLIDELL, LA 70458-1377
(504) 575-3712
Mailing address
2900 INDIANA AVE, KENNER, LA 70065-4605
(504) 575-3712
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
221224
LA
Other
Enumeration date
07/09/2021
Last updated
07/09/2021
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