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 1:912 BRYAN ST
Mailing Address - Street 2:
Mailing Address - City:COTTONPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71327-4288
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4855 HIGHWAY 10 WEST, SUITE C
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:LA
Practice Address - Zip Code:70638
Practice Address - Country:US
Practice Address - Phone:318-306-6055
Practice Address - Fax:318-306-6054
Is Sole Proprietor?:No
Enumeration Date:2012-08-11
Last Update Date:2024-11-18
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
LAAP07052Other:APRN LICENSE NO
LA021512OtherLA PA ID
LA021512OtherLA PA ID