Provider Demographics
NPI:1558483560
Name:MINOR, MICHELLE LYNDELL (NP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNDELL
Last Name:MINOR
Suffix:
Gender:F
Credentials:NP
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 66558
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70896-6558
Mailing Address - Country:US
Mailing Address - Phone:225-922-2700
Mailing Address - Fax:225-296-3034
Practice Address - Street 1:2751 WOODDALE BLVD STE 2
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-7567
Practice Address - Country:US
Practice Address - Phone:225-925-1906
Practice Address - Fax:855-473-0115
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04977363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily