Provider Demographics
NPI:1205496361
Name:LIVINGSTON, ANNA GRACE (AGNP-C)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:GRACE
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 BROADMOOR BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3184
Mailing Address - Country:US
Mailing Address - Phone:318-325-0600
Mailing Address - Fax:318-325-0890
Practice Address - Street 1:2509 BROADMOOR BLVD STE A
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3184
Practice Address - Country:US
Practice Address - Phone:318-325-0600
Practice Address - Fax:318-325-0890
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA206525363LA2200X, 363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology