Provider Demographics
NPI:1740761436
Name:BRISTER, ADRIAN L
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:L
Last Name:BRISTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-4720
Mailing Address - Country:US
Mailing Address - Phone:985-735-9448
Mailing Address - Fax:
Practice Address - Street 1:542 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-4720
Practice Address - Country:US
Practice Address - Phone:985-735-9448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator