Psychiatric Nurse Practitioners

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

RN79944 AP3962 Issued in LA

Legal business name

PSYCHIATRIC NURSE PRACTITIONERS

Practice address

1651 E 70TH St # 382
Shreveport, LA 71105-5115

Phone

(318) 560-5883

Fax

(318) 216-3940

NPI assigned

Feb 17, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Denise Knight

Title

Credentialing Admin

Phone

(845) 551-9673

Specialties & licenses 1

Addresses

Other identifiers 6

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1424131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1043601685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2208 KIBER ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711042045",
            "telephone_number": "318-560-5883",
            "fax_number": "318-617-1590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1651 E 70TH ST # 382",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055115",
            "telephone_number": "318-560-5883",
            "fax_number": "318-216-3940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHIATRIC NURSE PRACTITIONERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-17",
        "last_updated": "2023-03-07",
        "certification_date": "2021-07-22",
        "status": "A",
        "authorized_official_last_name": "KNIGHT",
        "authorized_official_first_name": "DENISE",
        "authorized_official_title_or_position": "CREDENTIALING ADMIN",
        "authorized_official_telephone_number": "845-551-9673"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "LA",
            "license": "RN79944 AP3962",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADVANCE PRACTICE (AP) LICENSE",
            "identifier": "3962",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDS",
            "identifier": "35169",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN LICENSE NO.",
            "identifier": "79944",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANCC CREDENTIALING",
            "identifier": "30188717",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1032026",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRESCRIPTIVE AUTHORITY (PA)",
            "identifier": "210016",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Provider Care Inc.
• Leslie Lewynell Provost
• Elizabeth Pruitt, M.ED
• Evelyn Baranco Pryor, MD
• Jeremy Edwin Pryor
• Psychology Associates of N.W. Louisiana, L.L.C.
• Kenisha Puckett-Threats
• Andrew James Puckett, MD
• Anna Puckett, COTA
• Jessie Puckett

• Psychiatric/Mental Health Nurse Practitioner in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.