Provider Demographics
NPI:1114709060
Name:GRAPPE, ELLEN (PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:
Last Name:GRAPPE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 E 70TH ST # 52421
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-0002
Mailing Address - Country:US
Mailing Address - Phone:659-243-9091
Mailing Address - Fax:
Practice Address - Street 1:1800 LINE AVE OFC 307
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4612
Practice Address - Country:US
Practice Address - Phone:318-379-4488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA211282363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health