Provider Demographics
NPI:1619727658
Name:BERTHELOT, CARISSA (PMHNP)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:BERTHELOT
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 ENGLISH COLONY DR
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-2345
Mailing Address - Country:US
Mailing Address - Phone:504-920-4344
Mailing Address - Fax:
Practice Address - Street 1:2520 ENGLISH COLONY DR
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-2345
Practice Address - Country:US
Practice Address - Phone:504-920-4344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA234822363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health