Individual
COURTNEY MARIE LACOSTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
16195 SAM FAVRE RD, KILN, MS 39556-8191
(228) 216-1981
Mailing address
PO BOX 481, KILN, MS 39556-0481
(228) 216-1981
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
906357
MS
Other
Enumeration date
11/03/2023
Last updated
11/03/2023
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