Healthcare Provider Details

I. General information

NPI: 1033432430
Provider Name (Legal Business Name): HAROLD WAYNE BERTRAND FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2010
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 PALMER ST
WELSH LA
70591-4320
US

IV. Provider business mailing address

287 PANTHER TRAIL DRIVE COUSHATTA FAMILY MEDICAL CENTER
KINDER LA
70648
US

V. Phone/Fax

Practice location:
  • Phone: 337-734-4901
  • Fax: 337-734-4338
Mailing address:
  • Phone: 337-738-4180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN114015-AP06062
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: