Organization · Type 2 NPI
Extraordinary Healthcare
Psychiatric/Mental Health Nurse Practitioner · Lake Charles, LA
NPI number
1033048160
Active
Practice location
900 Ryan St Ste 400
Lake Charles, LA 70601-9405
Mailing address
1130 Caesars Ct
Lake Charles, LA 70611-6739
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Nurse Practitioner | 363LF0000X | None listed |
| Psychiatric/Mental Health Nurse Practitioner Primary | 363LP0808X | None listed |
Psychiatric/Mental Health Nurse Practitioner: Definition to come...
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About NPI 1033048160
Extraordinary Healthcare's National Provider Identifier is 1033048160, issued on May 15, 2026. The primary taxonomy on file is Psychiatric/Mental Health Nurse Practitioner (363LP0808X), and the practice location is in Lake Charles, LA. The record was last updated on Oct 29, 2026.