Healthcare Provider Details

I. General information

NPI: 1861405698
Provider Name (Legal Business Name): SUSAN BROWN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 HIGHLAND AVE
SHREVEPORT LA
71101-4103
US

IV. Provider business mailing address

1006 HIGHLAND AVE
SHREVEPORT LA
71101-4103
US

V. Phone/Fax

Practice location:
  • Phone: 318-222-6226
  • Fax: 318-524-7252
Mailing address:
  • Phone: 318-222-6226
  • Fax: 318-524-7252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPO3514
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: