Provider Demographics
NPI:1902923220
Name:FOXWORTH, GWENDOLYN D (FNP)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:D
Last Name:FOXWORTH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2269 MILTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-4540
Mailing Address - Country:US
Mailing Address - Phone:504-909-7788
Mailing Address - Fax:504-903-1975
Practice Address - Street 1:1400 POYDRAS ST.
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2821
Practice Address - Country:US
Practice Address - Phone:504-903-1940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO1795363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1562793Medicaid
LA1562793Medicaid