Provider Demographics
NPI:1033432430
Name:BERTRAND, HAROLD WAYNE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:WAYNE
Last Name:BERTRAND
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 PANTHER TRAIL DRIVE
Mailing Address - Street 2:COUSHATTA FAMILY MEDICAL CENTER
Mailing Address - City:KINDER
Mailing Address - State:LA
Mailing Address - Zip Code:70648
Mailing Address - Country:US
Mailing Address - Phone:337-738-4180
Mailing Address - Fax:
Practice Address - Street 1:308 PALMER ST
Practice Address - Street 2:
Practice Address - City:WELSH
Practice Address - State:LA
Practice Address - Zip Code:70591-4320
Practice Address - Country:US
Practice Address - Phone:337-734-4901
Practice Address - Fax:337-734-4338
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN114015-AP06062363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily