Provider Demographics
NPI:1225481211
Name:TALBOT, M'LEA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:M'LEA
Middle Name:
Last Name:TALBOT
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:M'LEA
Other - Middle Name:
Other - Last Name:DEROUEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:123 FRONTAGE ROAD A
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:LA
Mailing Address - Zip Code:70359-6301
Mailing Address - Country:US
Mailing Address - Phone:985-580-1200
Mailing Address - Fax:985-580-1218
Practice Address - Street 1:123 FRONTAGE ROAD A
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:LA
Practice Address - Zip Code:70359-6301
Practice Address - Country:US
Practice Address - Phone:985-580-1200
Practice Address - Fax:985-580-1218
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08888363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily