Healthcare Provider Details

I. General information

NPI: 1932122587
Provider Name (Legal Business Name): NICOLE A BROWN RN,BSN,MSN,CANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 S MORRISON BLVD
HAMMOND LA
70403-5742
US

IV. Provider business mailing address

PO BOX 2668
HAMMOND LA
70404-2668
US

V. Phone/Fax

Practice location:
  • Phone: 985-230-6534
  • Fax: 985-230-6653
Mailing address:
  • Phone: 985-230-6534
  • Fax: 985-230-6653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP04271
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR55270
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR55270
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: