Provider Demographics
NPI:1558424366
Name:CHARLES, WRONETTA ANN (DNP, APRN, BC, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:WRONETTA
Middle Name:ANN
Last Name:CHARLES
Suffix:
Gender:F
Credentials:DNP, APRN, BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2161 BABE ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-3252
Mailing Address - Country:US
Mailing Address - Phone:337-290-0745
Mailing Address - Fax:
Practice Address - Street 1:5367 I 49 S SERVICE RD
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-0743
Practice Address - Country:US
Practice Address - Phone:337-678-0366
Practice Address - Fax:337-223-8301
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04507363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1479438Medicaid
LAQ41156Medicare UPIN