Healthcare Provider Details

I. General information

NPI: 1770065799
Provider Name (Legal Business Name): BRENTON LEE ALBRITTON NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 MAIN ST
MARION LA
71260-5253
US

IV. Provider business mailing address

PO BOX 792
BASTROP LA
71221-0792
US

V. Phone/Fax

Practice location:
  • Phone: 318-292-2795
  • Fax: 318-292-2785
Mailing address:
  • Phone: 318-283-8887
  • Fax: 318-281-2559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10188
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: