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NPI Code Detail

MEDICARE: MRS. CELESTE WOODARD BROWN FNP-C

MEDICARE: MRS. CELESTE WOODARD BROWN FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner211815LA
2363LF0000XFamily Nurse Practitioner211815LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1211815OTHERLASTATE LICENSE

General Provider Information

NPI Number : 1770192171
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CELESTE WOODARD BROWN FNP-C
Provider Business Mailing Address
First Line : PO BOX 122525 DEPT 2525
Second Line :
City : DALLAS
State : TX
Zip : 75312-0001
Country : US
Telephone Number : 337-494-2772
Fax Number :
Provider Business Practice Location Address
First Line : 1715 WOLF CIR
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70605-2353
Country : US
Telephone Number : 337-480-7499
Fax Number : 337-480-7498
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2020
Last Update Date : 09/26/2022

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