Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | RN073799 AP04560 | LA |
NPI | 1699827600 |
---|---|
Provider Name | Celeste Tolar Mcknight |
First Address | Lecompte, LA 71346-9508 |
Second Address | Simmesport, LA 71369-2180 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1470031 | (05) | LA |
Q33291 | (02) | LA |