Healthcare Provider Details

I. General information

NPI: 1063101244
Provider Name (Legal Business Name): NISHANT KUMAR ROUT D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 W OAK ST
PONCHATOULA LA
70454-3328
US

IV. Provider business mailing address

PO BOX 2036
PONCHATOULA LA
70454-2036
US

V. Phone/Fax

Practice location:
  • Phone: 985-986-7900
  • Fax: 985-386-7999
Mailing address:
  • Phone: 985-386-7900
  • Fax: 985-386-7999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number342892
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: