Healthcare Provider Details

I. General information

NPI: 1730128166
Provider Name (Legal Business Name): CLAYTON BOSSIER N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 08/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 W 134TH ST
CUT OFF LA
70345-4155
US

IV. Provider business mailing address

144 W 134TH ST
CUT OFF LA
70345-4155
US

V. Phone/Fax

Practice location:
  • Phone: 985-632-6233
  • Fax: 985-632-7526
Mailing address:
  • Phone: 985-632-6233
  • Fax: 985-632-7526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP04056
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: