Healthcare Provider Details

I. General information

NPI: 1518883669
Provider Name (Legal Business Name): DUON ROSAMORE PMHNP APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 DR MICHAEL DEBAKEY DR
LAKE CHARLES LA
70601-5864
US

IV. Provider business mailing address

800 CATHY ST
LAKE CHARLES LA
70615-2073
US

V. Phone/Fax

Practice location:
  • Phone: 337-478-9331
  • Fax:
Mailing address:
  • Phone: 337-478-9331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number247608
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: