Provider Demographics
NPI:1043601685
Name:PSYCHIATRIC NURSE PRACTITIONERS
Entity Type:Organization
Organization Name:PSYCHIATRIC NURSE PRACTITIONERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-551-9673
Mailing Address - Street 1:2208 KIBER ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2045
Mailing Address - Country:US
Mailing Address - Phone:318-560-5883
Mailing Address - Fax:318-617-1590
Practice Address - Street 1:1651 E 70TH ST # 382
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5115
Practice Address - Country:US
Practice Address - Phone:318-560-5883
Practice Address - Fax:318-216-3940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN79944 AP3962363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3962OtherADVANCE PRACTICE (AP) LICENSE
LA35169OtherCDS
LA79944OtherRN LICENSE NO.
30188717OtherANCC CREDENTIALING
LA1032026Medicaid
LA210016OtherPRESCRIPTIVE AUTHORITY (PA)
LA210016OtherPRESCRIPTIVE AUTHORITY (PA)
30188717OtherANCC CREDENTIALING
LA35169OtherCDS