Provider Demographics
NPI:1760865109
Name:LATOUR, BROOKLYN (FNP-C)
Entity Type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:
Last Name:LATOUR
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-4609
Mailing Address - Country:US
Mailing Address - Phone:337-336-5032
Mailing Address - Fax:337-506-2131
Practice Address - Street 1:504 JACK MILLER RD STE 1
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-5600
Practice Address - Country:US
Practice Address - Phone:337-336-5040
Practice Address - Fax:337-506-2122
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08355363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2400444Medicaid
LA440763YMMKMedicare PIN