Provider Demographics
NPI:1962406884
Name:COUTEE, CLARA BASCO (FNP)
Entity type:Individual
Prefix:MRS
First Name:CLARA
Middle Name:BASCO
Last Name:COUTEE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5541 HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-2650
Mailing Address - Country:US
Mailing Address - Phone:318-240-7240
Mailing Address - Fax:318-240-7780
Practice Address - Street 1:5541 HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-2650
Practice Address - Country:US
Practice Address - Phone:318-240-7240
Practice Address - Fax:318-240-7780
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN038164363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1693073Medicaid
LA4C127Medicare ID - Type Unspecified
LA1693073Medicaid