Individual
BRANTLEY BOOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
2829 4TH AVE STE 150, LAKE CHARLES, LA 70601-7897
(337) 480-7800
(337) 474-4552
Mailing address
2829 4TH AVE STE 150, LAKE CHARLES, LA 70601-7897
(337) 477-7091
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
230060
LA
Other
Enumeration date
05/16/2023
Last updated
09/14/2023
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