Provider Demographics
NPI:1558834150
Name:NEZAT, KOLT (APRN, FNP-C)
Entity Type:Individual
Prefix:MR
First Name:KOLT
Middle Name:
Last Name:NEZAT
Suffix:
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 MOOSA BLVD
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-3638
Mailing Address - Country:US
Mailing Address - Phone:337-457-2200
Mailing Address - Fax:
Practice Address - Street 1:281 MOOSA BLVD
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-3638
Practice Address - Country:US
Practice Address - Phone:337-457-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA202434363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily