Healthcare Provider Details

I. General information

NPI: 1598221798
Provider Name (Legal Business Name): CAITLIN MORRIS BACON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 CORPORATE DR STE 302
HOUMA LA
70360-2498
US

IV. Provider business mailing address

435 CORPORATE DR STE 302
HOUMA LA
70360-2498
US

V. Phone/Fax

Practice location:
  • Phone: 985-796-2446
  • Fax: 986-364-0978
Mailing address:
  • Phone: 985-796-2446
  • Fax: 985-364-0978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number203063
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-61021
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: