Provider Demographics
NPI:1851319602
Name:BOSSIER, TODD JOSEPH (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:JOSEPH
Last Name:BOSSIER
Suffix:
Gender:
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6304 E CASTLEDALE DR
Mailing Address - Street 2:
Mailing Address - City:GREENWELL SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70739-4206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:225-251-4502
Practice Address - Street 1:624 CONNELL PARK LN STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6534
Practice Address - Country:US
Practice Address - Phone:225-468-6287
Practice Address - Fax:225-251-4502
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN097469AP04275363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1162671Medicaid
LA1162671Medicaid