Provider Demographics
NPI:1053496562
Name:ATKINS-LUSTER, KOURTNI
Entity Type:Individual
Prefix:
First Name:KOURTNI
Middle Name:
Last Name:ATKINS-LUSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12521 SCHLAYER AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-8950
Mailing Address - Country:US
Mailing Address - Phone:225-931-4887
Mailing Address - Fax:
Practice Address - Street 1:8994 AIRLINE HWY
Practice Address - Street 2:STE. Q
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816
Practice Address - Country:US
Practice Address - Phone:225-922-8377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04774363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily