Provider Demographics
NPI:1366167801
Name:MOUTON, KOLLIN JAMES (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:MR
First Name:KOLLIN
Middle Name:JAMES
Last Name:MOUTON
Suffix:
Gender:M
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 RUE FONTAINE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5745
Mailing Address - Country:US
Mailing Address - Phone:337-534-8680
Mailing Address - Fax:337-769-9934
Practice Address - Street 1:118 RUE FONTAINE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5745
Practice Address - Country:US
Practice Address - Phone:337-534-8680
Practice Address - Fax:337-769-9934
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA227231363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily