Healthcare Provider Details

I. General information

NPI: 1578399507
Provider Name (Legal Business Name): CAROLINE H BROCKMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 N FRANKLIN ST
BASTROP LA
71220-3846
US

IV. Provider business mailing address

100 CENTURYLINK DR
MONROE LA
71203-2041
US

V. Phone/Fax

Practice location:
  • Phone: 318-283-8887
  • Fax: 318-281-6339
Mailing address:
  • Phone: 318-582-7272
  • Fax: 318-360-4876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number236048
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: