Provider Demographics
NPI:1457405318
Name:DOUGLASS, LINDA LEE (FNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LEE
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3746 CHAMPIONS DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-5471
Mailing Address - Country:US
Mailing Address - Phone:409-840-6942
Mailing Address - Fax:
Practice Address - Street 1:2501 JIMMY JOHNSON BLVD.
Practice Address - Street 2:SUITE 405
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640
Practice Address - Country:US
Practice Address - Phone:409-722-6553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX681827363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner