Provider Demographics
NPI:1821481516
Name:UNDERWOOD, DEMEKA (NP)
Entity Type:Individual
Prefix:
First Name:DEMEKA
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37112 COBBLESTONE AVE
Mailing Address - Street 2:
Mailing Address - City:GEISMAR
Mailing Address - State:LA
Mailing Address - Zip Code:70734-3260
Mailing Address - Country:US
Mailing Address - Phone:225-978-4578
Mailing Address - Fax:
Practice Address - Street 1:1505 N FLORIDA ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-1544
Practice Address - Country:US
Practice Address - Phone:985-900-1626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN139755163W00000X
LA218900363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse