Provider Demographics
NPI:1548151756
Name:MOULDER, LAURAN (FNP-C)
Entity type:Individual
Prefix:
First Name:LAURAN
Middle Name:
Last Name:MOULDER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4912 GENERAL POLK DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-4773
Mailing Address - Country:US
Mailing Address - Phone:318-617-4625
Mailing Address - Fax:
Practice Address - Street 1:4912 GENERAL POLK DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-4773
Practice Address - Country:US
Practice Address - Phone:318-617-4625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA133004163W00000X
LA241182363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse