Provider Demographics
NPI:1487084216
Name:WEST, MICHELDA (FNP)
Entity type:Individual
Prefix:
First Name:MICHELDA
Middle Name:
Last Name:WEST
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 GAUSE BLVD W
Mailing Address - Street 2:STE. A
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-4130
Mailing Address - Country:US
Mailing Address - Phone:985-643-4575
Mailing Address - Fax:985-643-4513
Practice Address - Street 1:3715 WILLIAMS BLVD
Practice Address - Street 2:STE. 100
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3075
Practice Address - Country:US
Practice Address - Phone:504-465-4550
Practice Address - Fax:504-465-8590
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAAPO7512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily