Provider Demographics
NPI:1811090053
Name:GAYLE, JULIE HELEN (DNP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:HELEN
Last Name:GAYLE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:HELEN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:510 E STONER AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4243
Mailing Address - Country:US
Mailing Address - Phone:318-221-8411
Mailing Address - Fax:
Practice Address - Street 1:510 E STONER AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4243
Practice Address - Country:US
Practice Address - Phone:318-227-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN10104 AP05004363LW0102X
LALAAP05004363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1506681Medicaid
TX207384301Medicaid
AR179375758Medicaid
TX207384301Medicaid
LA1506681Medicaid