Healthcare Provider Details

I. General information

NPI: 1730736208
Provider Name (Legal Business Name): BROOKE NICHOLE SUTTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 05/27/2024
Certification Date: 05/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 NORTHPOINTE LN STE 102
RUSTON LA
71270-3852
US

IV. Provider business mailing address

1200 S FARMERVILLE ST
RUSTON LA
71270-5941
US

V. Phone/Fax

Practice location:
  • Phone: 318-255-3762
  • Fax: 318-255-2866
Mailing address:
  • Phone: 318-807-1360
  • Fax: 318-807-1364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number206868
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN-CP206868
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: