Healthcare Provider Details

I. General information

NPI: 1033550686
Provider Name (Legal Business Name): MEGAN BAROUSSE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2013
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 MAIN ST
CANKTON LA
70584-5920
US

IV. Provider business mailing address

1091 JESSIE RICHARD RD
SUNSET LA
70584-5250
US

V. Phone/Fax

Practice location:
  • Phone: 337-668-4141
  • Fax: 337-668-4386
Mailing address:
  • Phone: 337-230-6535
  • Fax: 337-668-4386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPO7344
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: