Provider Demographics
NPI:1093251472
Name:MIRE, BRITTANY TROSCLAIR (APRN,FNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:TROSCLAIR
Last Name:MIRE
Suffix:
Gender:F
Credentials:APRN,FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:213 SAINT MARY ST STE 218
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-2634
Mailing Address - Country:US
Mailing Address - Phone:985-228-6223
Mailing Address - Fax:985-228-6230
Practice Address - Street 1:201 W 7TH ST STE 7
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-3242
Practice Address - Country:US
Practice Address - Phone:985-228-6223
Practice Address - Fax:985-228-6230
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAAP09107363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2438719Medicaid