Provider Demographics
NPI:1457383739
Name:AUSTIN, ANDERSON CLARK (FNPC)
Entity Type:Individual
Prefix:
First Name:ANDERSON
Middle Name:CLARK
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:FNPC
Other - Prefix:
Other - First Name:ANDY
Other - Middle Name:
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNPC
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:318-966-4400
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:309 JACKSON ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7407
Practice Address - Country:US
Practice Address - Phone:318-966-4000
Practice Address - Fax:318-966-7359
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04485363LF0000X
LARN094896 AP04485363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1073580Medicaid
LA4H385Medicare ID - Type Unspecified