Provider Demographics
NPI:1336475813
Name:DECLOUET-DIXON, MONIQUE BIANCA (FNP)
Entity type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:BIANCA
Last Name:DECLOUET-DIXON
Suffix:
Gender:
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:PO BOX 740012
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0012
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:
Practice Address - Street 1:536 ST. LANDRY VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:LA
Practice Address - Zip Code:70589
Practice Address - Country:US
Practice Address - Phone:337-628-5014
Practice Address - Fax:337-826-5401
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-19
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP059059363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1820105Medicaid