Provider Demographics
NPI:1962091066
Name:CROSS, CLAIRE ANNETTE (PMHNP)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:ANNETTE
Last Name:CROSS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 114
Mailing Address - Street 2:
Mailing Address - City:LIBUSE
Mailing Address - State:LA
Mailing Address - Zip Code:71348-0114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:242 W SHAMROCK AVE
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-6439
Practice Address - Country:US
Practice Address - Phone:318-484-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA218230363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health