Healthcare Provider Details

I. General information

NPI: 1760129985
Provider Name (Legal Business Name): BRITTANY YOUNG BULLOCK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19065 DR JOHN LAMBERT DR
HAMMOND LA
70403-0997
US

IV. Provider business mailing address

19065 DR JOHN LAMBERT DR
HAMMOND LA
70403-0997
US

V. Phone/Fax

Practice location:
  • Phone: 985-892-8934
  • Fax:
Mailing address:
  • Phone: 985-892-8934
  • Fax: 986-892-8937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number224317
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: