Provider Demographics
NPI:1033592886
Name:PORTIE, DARCI (NP)
Entity Type:Individual
Prefix:
First Name:DARCI
Middle Name:
Last Name:PORTIE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DARCI
Other - Middle Name:LANDRY
Other - Last Name:PORTIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:803 W BAYOU PINES DR STE B
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7096
Mailing Address - Country:US
Mailing Address - Phone:337-508-2333
Mailing Address - Fax:337-549-6316
Practice Address - Street 1:803 W BAYOU PINES DR STE B
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7096
Practice Address - Country:US
Practice Address - Phone:337-508-2333
Practice Address - Fax:337-549-6316
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08424363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2396676Medicaid
LA436736YH5NMedicare PIN