Provider Demographics
NPI:1013242825
Name:COLWART, ANNE BORNE (ANP-C)
Entity type:Individual
Prefix:MS
First Name:ANNE
Middle Name:BORNE
Last Name:COLWART
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-6240
Mailing Address - Country:US
Mailing Address - Phone:985-633-3150
Mailing Address - Fax:
Practice Address - Street 1:159 LONGVIEW DR STE C
Practice Address - Street 2:
Practice Address - City:DESTREHAN
Practice Address - State:LA
Practice Address - Zip Code:70047-5076
Practice Address - Country:US
Practice Address - Phone:985-764-7669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-12
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05955363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02009040Medicaid
LA2379569Medicaid
MS02009040Medicaid
LA371880YH3UMedicare PIN