Healthcare Provider Details

I. General information

NPI: 1073165940
Provider Name (Legal Business Name): AUTUMN LYNNE LAFFITTE WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUTUMN LYNNE BURKETT

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 E BERT KOUNS INDUSTRIAL LOOP # 308
SHREVEPORT LA
71105-6000
US

IV. Provider business mailing address

1455 E BERT KOUNS INDUSTRIAL LOOP
SHREVEPORT LA
71105-6000
US

V. Phone/Fax

Practice location:
  • Phone: 318-798-4400
  • Fax: 318-798-4525
Mailing address:
  • Phone: 318-798-4539
  • Fax: 318-798-4601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN146205
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: