Healthcare Provider Details

I. General information

NPI: 1922921287
Provider Name (Legal Business Name): CIERRA LACOUR DNP, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4152 BAKER ST NE
COVINGTON GA
30014-1404
US

IV. Provider business mailing address

4152 BAKER ST NE
COVINGTON GA
30014-1404
US

V. Phone/Fax

Practice location:
  • Phone: 770-788-1077
  • Fax:
Mailing address:
  • Phone: 770-788-1077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN-NP289057
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: