Provider Demographics
NPI:1730736208
Name:SUTTON, BROOKE NICHOLE (NP)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:NICHOLE
Last Name:SUTTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1200 S FARMERVILLE ST
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-5941
Mailing Address - Country:US
Mailing Address - Phone:318-807-1360
Mailing Address - Fax:318-807-1364
Practice Address - Street 1:1809 NORTHPOINTE LN STE 102
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-3852
Practice Address - Country:US
Practice Address - Phone:318-255-3762
Practice Address - Fax:318-255-2866
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2024-05-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA206868363LF0000X
LAAPRN-CP206868363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily