Healthcare Provider Details

I. General information

NPI: 1831444843
Provider Name (Legal Business Name): TRENTON D BRATTON FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HART ST
MONROE LA
71201-7504
US

IV. Provider business mailing address

PO BOX 3064
MONROE LA
71210-3064
US

V. Phone/Fax

Practice location:
  • Phone: 318-966-1382
  • Fax: 318-322-6530
Mailing address:
  • Phone: 318-966-1382
  • Fax: 318-322-6530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP06989
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: