Provider Demographics
NPI:1295892453
Name:WOOTEN, LEANN DEVUN (CRNA-MSNA)
Entity type:Individual
Prefix:MS
First Name:LEANN
Middle Name:DEVUN
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:CRNA-MSNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 SARAH LYNNE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2096
Mailing Address - Country:US
Mailing Address - Phone:318-308-3840
Mailing Address - Fax:318-767-5344
Practice Address - Street 1:2495 SHEVEPORT HWY
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4044
Practice Address - Country:US
Practice Address - Phone:318-473-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA056798-2906367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1690741Medicaid
LA5X166Medicare UPIN