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General NPI Number Information
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NPI Number | 1851319602
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Entity Type | Individual
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Provider Name | TODD JOSEPH BOSSIER NURSE PRACTITIONER
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 624 CONNELL PARK LN STE A
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City | BATON ROUGE
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State | LA
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Zip | 70806-6534
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Country | US
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Telephone | 225-468-6287
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Fax | 225-251-4502
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Provider Business Mailing Address
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Address Line | 6304 E CASTLEDALE DR
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City | GREENWELL SPRINGS
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State | LA
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Zip | 70739-4206
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Country | US
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Telephone |
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Fax | 225-251-4502
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN097469AP04275
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License Number State | LA
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