Individual
CHARLISSA WHITTED
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2110 OAK PARK BLVD, LAKE CHARLES, LA 70601-7864
(337) 263-3792
Mailing address
7494 COLUMBIA DR, LAKE CHARLES, LA 70605-0286
(337) 794-0113
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
20120941
LA
Other
Enumeration date
01/25/2021
Last updated
01/25/2021
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