Healthcare Provider Details

I. General information

NPI: 1225794431
Provider Name (Legal Business Name): MERISSA BRAUD ACNPC-AG, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 NORTH BLVD
BATON ROUGE LA
70806-3825
US

IV. Provider business mailing address

9516 AIRLINE HWY
BATON ROUGE LA
70815-5501
US

V. Phone/Fax

Practice location:
  • Phone: 225-655-6422
  • Fax:
Mailing address:
  • Phone: 225-655-6422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number221982
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number221982
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: