Provider Demographics
NPI:1003427899
Name:BROWN, COLLETTE G (NP-C)
Entity type:Individual
Prefix:MRS
First Name:COLLETTE
Middle Name:G
Last Name:BROWN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 LAZYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71108-5911
Mailing Address - Country:US
Mailing Address - Phone:318-423-2538
Mailing Address - Fax:
Practice Address - Street 1:2449 HOSPITAL DR STE 400
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-1914
Practice Address - Country:US
Practice Address - Phone:318-212-7902
Practice Address - Fax:318-212-7905
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA213785363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology