Provider Demographics
NPI:1508507237
Name:LACOUTURE, MICHELLE LYNN (ARNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:LACOUTURE
Suffix:
Gender:F
Credentials:ARNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX B
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:52767-0401
Mailing Address - Country:US
Mailing Address - Phone:563-340-8470
Mailing Address - Fax:
Practice Address - Street 1:1225 E RIVER DR STE 205
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-5752
Practice Address - Country:US
Practice Address - Phone:563-340-8470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2023-10-05
Deactivation Date:2022-06-29
Deactivation Code:
Reactivation Date:2022-07-26
Provider Licenses
StateLicense IDTaxonomies
IL41420485163W00000X
WA60941765163W00000X
IA132648163W00000X
CA95164367163W00000X
HI93013163W00000X
IAG169727363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse