Provider Demographics
NPI:1073502191
Name:BLANSON, DEBORAH S (FNP)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:S
Last Name:BLANSON
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 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-765-5727
Mailing Address - Fax:225-765-4278
Practice Address - Street 1:9644 HIGHWAY 165 N
Practice Address - Street 2:
Practice Address - City:STERLINGTON
Practice Address - State:LA
Practice Address - Zip Code:71280-3185
Practice Address - Country:US
Practice Address - Phone:318-966-8800
Practice Address - Fax:318-966-8801
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO3485363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00150405OtherRAILROAD MEDICRE
LA1561461Medicaid
LA5P013Medicare PIN
LAS89422Medicare UPIN