Healthcare Provider Details

I. General information

NPI: 1942819131
Provider Name (Legal Business Name): ALISHA BERNARD ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 3RD AVE STE 210
LAKE CHARLES LA
70601-0404
US

IV. Provider business mailing address

PO BOX 122579 DEPT 2579
DALLAS TX
75312-0001
US

V. Phone/Fax

Practice location:
  • Phone: 337-494-6768
  • Fax: 337-494-6792
Mailing address:
  • Phone: 337-494-2921
  • Fax: 337-494-6523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number212318
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: