Provider Demographics
NPI:1770192171
Name:BROWN, CELESTE WOODARD (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CELESTE
Middle Name:WOODARD
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:CELESTE
Other - Middle Name:WOODARD
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 122525 DEPT 2525
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-0001
Mailing Address - Country:US
Mailing Address - Phone:337-494-2772
Mailing Address - Fax:
Practice Address - Street 1:1715 WOLF CIR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-2353
Practice Address - Country:US
Practice Address - Phone:337-480-7499
Practice Address - Fax:337-480-7498
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA211815363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA211815OtherSTATE LICENSE