Loustalot, Fleetwood

Loustalot, Fleetwood is an individual health care provider with primary practice located at 2 Lakeview Cv , Hattiesburg MS 39402-8528. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as his primary health care specialty. Loustalot, Fleetwood can be contacted via phone (601) 264-2657.

Contact Information

Primary practice address
2 Lakeview Cv Hattiesburg MS 39402-8528
Phone: (601) 264-2657
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X R864143 Mississippi

Profile Details

NPI number 1164470928
LBN Legal business name Loustalot, Fleetwood
Credentials RN, NP-C, PHD
Entity Individual
Sole proprietor 1 No
Enumeration date May 4th, 2006
Last updated Jan 5th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164470928 NPPES
Mississippi MEDICAID 0126734
Mississippi Other R864143

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