Provider Demographics
NPI:1225074719
Name:OLDHAM, AIMEE DENISE (NP)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:DENISE
Last Name:OLDHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:DENISE
Other - Last Name:CLAUSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-526-0011
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:3400 MEDICAL PARK DR STE B
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2300
Practice Address - Country:US
Practice Address - Phone:318-387-6803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001434363LF0000X
LAAP09278363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200422460Medicaid
LA2452029Medicaid
IN200422460Medicaid