Healthcare Provider Details

I. General information

NPI: 1982604187
Provider Name (Legal Business Name): CORINNE KAUFFELD ROUGEAU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5131 ODONOVAN DR
BATON ROUGE LA
70808-4791
US

IV. Provider business mailing address

5131 ODONOVAN DR
BATON ROUGE LA
70808-4791
US

V. Phone/Fax

Practice location:
  • Phone: 225-374-0220
  • Fax: 225-374-0221
Mailing address:
  • Phone: 225-374-0220
  • Fax: 225-374-0221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP02285
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAP02285
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: