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NPI Code Detail

MEDICARE: PROSPER & BLOOM MENTAL HEALTH, INC

MEDICARE: PROSPER & BLOOM MENTAL HEALTH, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number : 1619662244
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROSPER & BLOOM MENTAL HEALTH, INC
Provider Business Mailing Address
First Line : 1765 ONEAL LN # 479
Second Line :
City : BATON ROUGE
State : LA
Zip : 70816-1633
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 301 MAIN ST STE 2200
Second Line :
City : BATON ROUGE
State : LA
Zip : 70801-0014
Country : US
Telephone Number : 225-605-3103
Fax Number :
Authorized Official
Title or Position : MEMBER
Name : ANISSA WOMACK
Credential : PMHNP-BC
Telephone Number : 225-605-3103
Provider Enumeration Date : 04/10/2023
Last Update Date : 05/27/2026

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Directions to “PROSPER & BLOOM MENTAL HEALTH, INC ” Practice Location

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