Healthcare Provider Details

I. General information

NPI: 1669040473
Provider Name (Legal Business Name): ELIZABETH NICHOLS TROUTMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 DUNAND ST
LAFAYETTE LA
70501-2215
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 337-470-3362
  • Fax:
Mailing address:
  • Phone: 337-470-3362
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number218954
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number218954
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: