Individual
LAQUINTEN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
323 W WALNUT AVE, BASTROP, LA 71220-4521
(318) 218-6077
Mailing address
PO BOX 293, BASTROP, LA 71221-0293
(318) 283-3910
(318) 239-8910
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
229719
LA
Other
Enumeration date
06/08/2023
Last updated
08/17/2023
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