Provider Demographics
NPI:1073165940
Name:LAFFITTE, AUTUMN LYNNE (WHNP)
Entity Type:Individual
Prefix:MS
First Name:AUTUMN
Middle Name:LYNNE
Last Name:LAFFITTE
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:LYNNE
Other - Last Name:BURKETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1455 E BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-6000
Mailing Address - Country:US
Mailing Address - Phone:318-798-4539
Mailing Address - Fax:318-798-4601
Practice Address - Street 1:1455 E BERT KOUNS INDUSTRIAL LOOP # 308
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-6000
Practice Address - Country:US
Practice Address - Phone:318-798-4400
Practice Address - Fax:318-798-4525
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN146205363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology