Provider Demographics
NPI:1164299764
Name:HOWARD-BOURQUE, CELESTE M (PMHNP-BC, APRN)
Entity Type:Individual
Prefix:MRS
First Name:CELESTE
Middle Name:M
Last Name:HOWARD-BOURQUE
Suffix:
Gender:F
Credentials:PMHNP-BC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4544 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-3729
Mailing Address - Country:US
Mailing Address - Phone:337-739-9824
Mailing Address - Fax:
Practice Address - Street 1:4544 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-3729
Practice Address - Country:US
Practice Address - Phone:337-739-9824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1152741363LP0808X
LA208628363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty