Provider Demographics
NPI:1013264878
Name:GATES, PAULA WEAVER (APRN)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:WEAVER
Last Name:GATES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 GATES DR
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:LA
Mailing Address - Zip Code:71006-4119
Mailing Address - Country:US
Mailing Address - Phone:318-518-8329
Mailing Address - Fax:
Practice Address - Street 1:188 BURT BLVD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:LA
Practice Address - Zip Code:71006-4900
Practice Address - Country:US
Practice Address - Phone:318-965-5017
Practice Address - Fax:318-965-5019
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-11
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07052363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2345419Medicaid
LA021512OtherLA PA ID
LAAP07052Other:APRN LICENSE NO
LA021512OtherLA PA ID