Provider Demographics
NPI:1346705100
Name:PICOU, ALISA (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:ALISA
Middle Name:
Last Name:PICOU
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52212 DITTA DR
Mailing Address - Street 2:
Mailing Address - City:LORANGER
Mailing Address - State:LA
Mailing Address - Zip Code:70446-2249
Mailing Address - Country:US
Mailing Address - Phone:985-320-9048
Mailing Address - Fax:
Practice Address - Street 1:16061 DOCTORS BLVD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1499
Practice Address - Country:US
Practice Address - Phone:985-542-1334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA203532363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily