Provider Demographics
NPI:1538816616
Name:DELASALLE, AMBER (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:
Last Name:DELASALLE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15770 PAUL VEGA MD DR STE 202
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1475
Mailing Address - Country:US
Mailing Address - Phone:985-230-7495
Mailing Address - Fax:985-230-7496
Practice Address - Street 1:15770 PAUL VEGA MD DR STE 202
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1475
Practice Address - Country:US
Practice Address - Phone:985-230-7495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS897729163W00000X
LA145631163W00000X
LA225431363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1538816616OtherNPPES
LA2593340Medicaid