Provider Demographics
NPI:1598499188
Name:CLEVELAND, NATASHA DEJEAN (NP)
Entity Type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:DEJEAN
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:DE'JEAN
Other - Last Name:CLEVELAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:209 DAYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-9204
Mailing Address - Country:US
Mailing Address - Phone:318-816-5116
Mailing Address - Fax:
Practice Address - Street 1:1501 STUBBS AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5627
Practice Address - Country:US
Practice Address - Phone:318-816-5116
Practice Address - Fax:318-855-3429
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA224390363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA224390OtherSTATE BOARD OF NURSING LICENSE