Healthcare Provider Details

I. General information

NPI: 1508507237
Provider Name (Legal Business Name): MICHELLE LYNN LACOUTURE ARNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date: 06/29/2022
Reactivation Date: 07/26/2022

III. Provider practice location address

1225 E RIVER DR STE 205
DAVENPORT IA
52803-5752
US

IV. Provider business mailing address

PO BOX B
PLEASANT VALLEY IA
52767-0401
US

V. Phone/Fax

Practice location:
  • Phone: 563-340-8470
  • Fax:
Mailing address:
  • Phone: 563-340-8470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number41420485
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number60941765
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number132648
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95164367
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number93013
License Number StateHI
# 6
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG169727
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: