Provider Demographics
NPI:1124694989
Name:ADAMS, MICHELLE W (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:W
Last Name:ADAMS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-2817
Mailing Address - Country:US
Mailing Address - Phone:337-202-4101
Mailing Address - Fax:337-202-4052
Practice Address - Street 1:1017 N PINE ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-2817
Practice Address - Country:US
Practice Address - Phone:337-202-4101
Practice Address - Fax:337-202-4052
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA211983363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily