Provider Demographics
NPI:1164430526
Name:DARTY, ROSALINE MICHELLE (AP NP)
Entity Type:Individual
Prefix:MS
First Name:ROSALINE
Middle Name:MICHELLE
Last Name:DARTY
Suffix:
Gender:F
Credentials:AP NP
Other - Prefix:MS
Other - First Name:ROSALINE
Other - Middle Name:MICHELLE
Other - Last Name:CALDWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AP NP
Mailing Address - Street 1:2508 BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3133
Mailing Address - Country:US
Mailing Address - Phone:318-212-5880
Mailing Address - Fax:318-212-5885
Practice Address - Street 1:1625 DAVID RAINES RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-5899
Practice Address - Country:US
Practice Address - Phone:318-425-2252
Practice Address - Fax:318-425-2367
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04803163WP0200X, 363LP0808X
LARN088507-AP04803363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1714429Medicaid
LA3C449Medicare PIN