Individual
PRISCILLA BROOKE MULLICAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2106 LOOP RD, WINNSBORO, LA 71295-3344
(318) 435-9411
Mailing address
2106 LOOP RD, WINNSBORO, LA 71295-3344
(318) 435-9411
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
202877
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15434420
CAQH
LA
05
—
2584286
—
LA
Enumeration date
10/21/2019
Last updated
05/30/2024
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