Provider Demographics
NPI:1134103708
Name:DARBONNE, CONSTANCE M (CFNP)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:M
Last Name:DARBONNE
Suffix:
Gender:F
Credentials:CFNP
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 765
Mailing Address - Street 2:
Mailing Address - City:LAKE ARTHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70549-0765
Mailing Address - Country:US
Mailing Address - Phone:337-774-0100
Mailing Address - Fax:337-774-0111
Practice Address - Street 1:328 KELLOGG AVE
Practice Address - Street 2:
Practice Address - City:LAKE ARTHUR
Practice Address - State:LA
Practice Address - Zip Code:70549-4116
Practice Address - Country:US
Practice Address - Phone:337-774-0100
Practice Address - Fax:337-774-0111
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO3171363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAPO3171OtherADV. PRACTICE NURSE PRACT
LA1431842Medicaid
LAMD0994788OtherDRUG ENFORCEM. ADM. NO.
LAS55011Medicare UPIN
LAMD0994788OtherDRUG ENFORCEM. ADM. NO.