Provider Demographics
NPI:1568815108
Name:LANCLOS, ANNIE KILBURN (FNP)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:KILBURN
Last Name:LANCLOS
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 1:9373 BARINGER FOREMAN RD BLDG 2
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-6200
Mailing Address - Country:US
Mailing Address - Phone:225-754-8888
Mailing Address - Fax:225-755-2147
Practice Address - Street 1:9373 BARINGER FOREMAN RD BLDG 2
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-6200
Practice Address - Country:US
Practice Address - Phone:225-754-8888
Practice Address - Fax:225-755-2147
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-151280363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily