Provider Demographics
NPI:1659667301
Name:CCP ENTERPRISES, LLC
Entity Type:Organization
Organization Name:CCP ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK-PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:225-281-0324
Mailing Address - Street 1:19111 BELLERIVE COURT
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809
Mailing Address - Country:US
Mailing Address - Phone:225-281-0324
Mailing Address - Fax:225-755-7482
Practice Address - Street 1:19111 BELLERIVE CT
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-6736
Practice Address - Country:US
Practice Address - Phone:225-281-0324
Practice Address - Fax:225-755-7482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP0441363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H079Medicare UPIN