Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 203935 | LA |
NPI | 1003374620 |
---|---|
Provider Name | Ms. Jessica Lynn Brousse |
First Address | Baton Rouge, LA 70808 |
Second Address | Baton Rouge, LA 70808-4375 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2019 |
Last Update Date | 22/01/2021 |