Healthcare Provider Details

I. General information

NPI: 1952445249
Provider Name (Legal Business Name): BRYANT ANTHONY ACOSTA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 W COURT ST STE B
WINNFIELD LA
71483-2686
US

IV. Provider business mailing address

431 W LAFAYETTE ST
WINNFIELD LA
71483-3463
US

V. Phone/Fax

Practice location:
  • Phone: 318-209-4646
  • Fax: 318-209-4649
Mailing address:
  • Phone: 318-648-0375
  • Fax: 318-648-0378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.A10303.RX
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberPO835285
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: