Healthcare Provider Details

I. General information

NPI: 1962813014
Provider Name (Legal Business Name): NIKKI L TOUSSAINT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 N. FUSILIER AVE.
BASILE LA
70515-3910
US

IV. Provider business mailing address

1431 N. FUSILIER AVE.
BASILE LA
70515-5601
US

V. Phone/Fax

Practice location:
  • Phone: 337-432-0200
  • Fax: 337-432-0202
Mailing address:
  • Phone: 337-432-0200
  • Fax: 337-432-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPO7590
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: