Provider Demographics
NPI:1932122587
Name:BROWN, NICOLE A (RN,BSN,MSN,CANP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:A
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN,BSN,MSN,CANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2668
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-2668
Mailing Address - Country:US
Mailing Address - Phone:985-230-6534
Mailing Address - Fax:985-230-6653
Practice Address - Street 1:1902 S MORRISON BLVD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5742
Practice Address - Country:US
Practice Address - Phone:985-230-6534
Practice Address - Fax:985-230-6653
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN095085163W00000X
LAAP04271363L00000X
NDR55270363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1167193Medicaid
LA1167193Medicaid
4C815Medicare ID - Type Unspecified