Provider Demographics
NPI:1164845905
Name:LAROCQUE, ALICIA (APRN)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:LAROCQUE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 PETE MANENA RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:LA
Mailing Address - Zip Code:70669-8112
Mailing Address - Country:US
Mailing Address - Phone:337-882-1550
Mailing Address - Fax:
Practice Address - Street 1:10071 GULF HWY
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-8672
Practice Address - Country:US
Practice Address - Phone:337-905-2151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07638363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily